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WALMART INC.
NPI 1194063008
Pharmacy - Community/Retail Pharmacy in Omaha, NE

Active since January 28, 2013CLIA 28D2129375 · Waiver
13105 BIRCH DR, OMAHA, NE 68164(402) 686-2058(402) 493-0730 Get Directions Write a Review

NPPES record last updated: June 5, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 5, 2025, Jul 19, 2018, Feb 26, 2018 and 3 more (6 updates tracked since 2015).

About Walmart Inc. NPPES

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

WALMART INC. (NPI 1194063008), doing business as Walmart Pharmacy 10-4138, is a healthcare organization registered as a community/retail pharmacy in Omaha, Nebraska and active in the NPI registry since January 2013. The organization holds a CLIA Waiver certificate valid through April 17, 2027 and lists Kimberly Canonic, Senior Director, Enrollment, as its authorized official.

NPPES Registry Identity

NPI1194063008
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameWALMART INC.
Location Address13105 BIRCH DROmaha, NE 68164-5222
Mailing Address702 Sw 8th StBentonville, AR 72716-0445 · (479) 204-8741 · Fax (479) 277-4331
Phone(402) 686-2058
Fax(402) 493-0730
Organization SubpartNo
Authorized OfficialKimberly CanonicSenior Director, Enrollment · (480) 277-6348
Enumeration DateJanuary 28, 2013
Last NPPES UpdateJune 5, 20256 updates tracked since enumeration
NPPES CertifiedJune 5, 2025
✔ NPI 1194063008 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 NE · 2961
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
13105 BIRCH DR, Omaha, NE 68164
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Other Names 1

Doing Business AsWalmart Pharmacy 10-4138

Other Identifiers 2

Medicaid100262713-00NE
Other2138827Pk

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 28D2129375

Walmart Pharmacy 10-4138 · Omaha, NE
Active · expires Apr 17, 2027
CLIA Number28D2129375
Laboratory TypePharmacy
Certificate Effective DateApril 18, 2025
Certificate Expiration DateApril 17, 2027
Laboratory DirectorMs. Jane Jaworski-Andersen
Laboratory Phone(402) 686-2058
Laboratory LocationWalmart Pharmacy 10-413813105 Birch Dr, Omaha, NE 68164
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.
228 services227 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.
224 services223 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.
21 services21 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.
13 services13 patients

Medical Equipment Supplier Medicare DMEPOS 11

Medicare supplier enrollment and the product categories Wal-Mart Pharmacy 10-4138 carries, from the Medicare DMEPOS supplier directory.

Wal-Mart Pharmacy 10-4138

DMEPOS supplier · Omaha, NEOperated by Walmart Inc
⋮

Does not accept Medicare assignment

Wal-Mart Pharmacy 10-4138 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)20441177
Medicare Participant SinceJanuary 1, 2019
Supplier Location13105 Birch DrOmaha, NE 68164
Phone(402) 686-2058
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 3

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

KELLI WYANT PHARM.D.
Pharmacist
13105 BIRCH DR
OMAHA, NE 68164
Douglas County (402) 686-2058
STEPHANIE ANNE SEMPLE PHARMD
Pharmacist
13105 BIRCH DR
OMAHA, NE 68164
Douglas County (402) 686-2058
SAMANTHA ANN KANALY
Pharmacist
13105 BIRCH DR
OMAHA, NE 68164
Douglas County (402) 686-2058

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 1194063008. It was assigned to this organization in the NPPES registry on January 28, 2013. The provider is doing business as WalMart Pharmacy 10-4138.

Where is Walmart Inc. located?

Walmart Inc. is located at 13105 Birch Dr, Omaha, NE 68164. The listed phone number is (402) 686-2058.

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. accept Medicare assignment for medical equipment?

No. As a Medicare medical equipment supplier, Wal-Mart Pharmacy 10-4138 does not accept Medicare assignment for equipment and supplies, so patients may be charged more than the Medicare-approved amount. Confirm the expected cost with the supplier before ordering.

Does Walmart Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 28D2129375) is associated with this NPI, valid through April 17, 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 49 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 5, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.