WALMART INC.
NPI 1023035219
Pharmacy - Community/Retail Pharmacy in Salt Lake City, UT

Active since July 16, 2006CLIA 46D2140927 · Waiver
4627 S 900 E, SALT LAKE CITY, UT 84117(801) 261-3818 Get Directions Write a Review

NPPES record last updated: June 13, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jun 13, 2025, Feb 28, 2018, Feb 17, 2017 (3 updates tracked since 2017).

About Walmart Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WALMART INC. (NPI 1023035219) is a healthcare organization registered as a community/retail pharmacy in Salt Lake City, Utah and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through December 3, 2027 and lists Kimberly Canonic, Senior Director, Enrollment, as its authorized official.

NPPES Registry Identity

NPI1023035219
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameWALMART INC.
Location Address4627 S 900 ESalt Lake City, UT 84117-4879
Mailing Address702 Sw 8th StBentonville, AR 72716-0445
Organization SubpartNo
Authorized OfficialKimberly CanonicSenior Director, Enrollment · (480) 853-0515
Enumeration DateJuly 16, 2006
Last NPPES UpdateJune 13, 20253 updates tracked since enumeration
NPPES CertifiedJune 13, 2025
NPI 1023035219 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License Licensed in UT · 56290761703
Definition

A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X
Also ListedPharmacyTaxonomy 333600000X
4627 S 900 E, Salt Lake City, UT 84117

Other Identifiers 1

Other2100777Pk

Accepted Insurance

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 46D2140927

Walmart Pharmacy 10-5350 · Salt Lake City, UT
Active · expires Dec 3, 2027
CLIA Number46D2140927
Laboratory TypePharmacy
Certificate Effective DateDecember 4, 2025
Certificate Expiration DateDecember 3, 2027
Laboratory DirectorNina Barsegian
Laboratory Phone(801) 261-3818
Laboratory LocationWalmart Pharmacy 10-53504627 S 900 E, Salt Lake City, UT 84117
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
220 services219 patients
Influenza vaccine split virus, preservative free 90662
The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
213 services212 patients
Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use 90677
The Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.
25 services25 patients
Administration of pneumococcal vaccine G0009
The pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.
25 services25 patients

Medical Equipment Supplier Medicare DMEPOS 11

Medicare supplier enrollment and the product categories Wal Mart Pharmacy 10-5350 carries, from the Medicare DMEPOS supplier directory.

Wal Mart Pharmacy 10-5350

DMEPOS supplier · Salt Lake City, UTOperated by Walmart Inc

Does not accept Medicare assignment

Wal Mart Pharmacy 10-5350 has not agreed to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients may be charged more than the Medicare-approved amount; confirm the expected cost with the supplier before ordering.

PTAN (Medicare Supplier Number)20440925
Medicare Participant SinceJanuary 1, 2019
Supplier Location4627 S 900 ESalt Lake City, UT 84117
Supplier Specialties
Pharmacy

Medicare Product Categories

Epoetin
Epoetin is a man-made version of human erythropoietin (EPO)
Immunosuppressive Drugs
Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
Infusion Drugs
Nebulizer Drugs
Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
Oral Anticancer Drugs
FDA anticancer drugs
Oral Antiemetic Drugs
FDA antiemetic drugs
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Pharmacist
4627 S 900 E
MURRAY, UT 84117
Pharmacist
4627 S 900 E
SALT LAKE CITY, UT 84117
Pharmacist
4627 S 900 E
SALT LAKE CITY, UT 84117
Eyewear Supplier
4627 S 900 E
SALT LAKE CITY, UT 84117

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1023035219, enumerated as an "organization" on July 16, 2006.

The provider is located at 4627 S 900 E SALT LAKE CITY, UT 84117 and the phone number is (801) 261-3818.

Pharmacy with taxonomy code 3336C0003X and a focus in Community/Retail Pharmacy.

The provider might be accepting Accepts: Alliant Health Plans, Inc., Ambetter from Absolute. Please consult your insurance carrier or call the provider to verify.