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WALMART INC.
NPI 1114944410
Pharmacy - Community/Retail Pharmacy in Rockford, IL

Active since July 16, 2006CLIA 14D2139571 · Waiver
3902 W RIVERSIDE BLVD, ROCKFORD, IL 61101(815) 962-4763 Get Directions Write a Review

NPPES record last updated: June 13, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 13, 2025, Feb 28, 2018, Feb 20, 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 1114944410) is a healthcare organization registered as a community/retail pharmacy in Rockford, Illinois and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through November 5, 2027 and lists Kimberly Canonic, Senior Director, Enrollment, as its authorized official.

NPPES Registry Identity

NPI1114944410
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameWALMART INC.
Location Address3902 W RIVERSIDE BLVDRockford, IL 61101-9507
Mailing Address702 Sw 8th StBentonville, AR 72716-0445
Phone(815) 962-4763
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 1114944410 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 IL · 054015468
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
3902 W RIVERSIDE BLVD, Rockford, IL 61101
Open in Google Maps ↗

Other Identifiers 1

Other2021775Pk

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health and more.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 14D2139571

Walmart Pharmacy 10-5398 · Rockford, IL
Active · expires Nov 5, 2027
CLIA Number14D2139571
Laboratory TypePharmacy
Certificate Effective DateNovember 6, 2025
Certificate Expiration DateNovember 5, 2027
Laboratory DirectorLeah Markham
Laboratory Phone(815) 962-4763
Laboratory LocationWalmart Pharmacy 10-53983902 W Riverside Blvd, Rockford, IL 61101
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 2

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.
79 services78 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.
76 services75 patients

Other Providers at the Same Location NPPES 6

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

WAL-MART STORES, INC
Eyewear Supplier
3902 W RIVERSIDE BLVD
ROCKFORD, IL 61101
Winnebago County (815) 962-4071
ULLMANN EYE CARE, LLC
Optometrist
3902 W RIVERSIDE BLVD
ROCKFORD, IL 61101
Winnebago County (847) 343-3678
DR. NNEKA NICKY ANIZOBA RPH
Pharmacist
3902 W RIVERSIDE BLVD
ROCKFORD, IL 61101
Winnebago County (815) 962-4071
INTEGRATED HOMECARE SERVICES
Durable Medical Equipment & Medical Supplies (Oxygen Equipment & Supplies)
3902 W RIVERSIDE BLVD
ROCKFORD, IL 61101
Winnebago County (815) 962-0202
RODICA DEDU
Pharmacist
3902 W RIVERSIDE BLVD
ROCKFORD, IL 61101
Winnebago County (815) 962-4071
MICHIAO E CHAI
Pharmacist
3902 W RIVERSIDE BLVD
ROCKFORD, IL 61101
Winnebago County (815) 962-4763

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Walmart Inc.'s NPI number?

The NPI number for Walmart Inc. is 1114944410. It was assigned to this organization in the NPPES registry on July 16, 2006.

Where is Walmart Inc. located?

Walmart Inc. is located at 3902 W Riverside Blvd, Rockford, IL 61101. The listed phone number is (815) 962-4763.

What is Walmart Inc.'s specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Does Walmart Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D2139571) is associated with this NPI, valid through November 5, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Walmart Inc. accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arizona Complete Health and 50 other insurers list Walmart Inc. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Walmart Inc. was last updated on June 13, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.