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WALMART INC.
NPI 1205853553
Pharmacy - Community/Retail Pharmacy in Pomona, CA

Active since July 16, 2006CLIA 05D2340712 · Waiver
80 RIO RANCHO RD, POMONA, CA 91766(909) 620-4077(909) 620-0747 Get Directions Write a Review

NPPES record last updated: September 29, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 19, 2025, Aug 29, 2023, Jul 19, 2018 and 4 more (7 updates tracked since 2016).

About Walmart Inc. NPPES

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

WALMART INC. (NPI 1205853553), doing business as Walmart Pharmacy 10-2288, is a healthcare organization registered as a community/retail pharmacy in Pomona, California and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through March 19, 2028 and lists Kimberly Canonic, Sr. Director, as its authorized official.

NPPES Registry Identity

NPI1205853553
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameWALMART INC.
Location Address80 RIO RANCHO RDPomona, CA 91766-4771
Mailing Address1 Customer Dr, Ms 0445Bentonville, AR 72716-0445
Phone(909) 620-4077
Fax(909) 620-0747
Organization SubpartNo
Authorized OfficialKimberly CanonicSr. Director · (479) 371-1168
Enumeration DateJuly 16, 2006
Last NPPES UpdateSeptember 29, 20257 updates tracked since enumeration
NPPES CertifiedSeptember 29, 2025
✔ NPI 1205853553 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 CA · PHY41296
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
80 RIO RANCHO RD, Pomona, CA 91766
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Other Names 1

Doing Business AsWalmart Pharmacy 10-2288

Other Identifiers 2

Other1998725Pk
Medicaid463PHA412960CA

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 05D2340712

Walmart Pharmacy #10-2288 · Pomona, CA
Active · expires Mar 19, 2028
CLIA Number05D2340712
Laboratory TypePharmacy
Certificate Effective DateMarch 20, 2026
Certificate Expiration DateMarch 19, 2028
Laboratory DirectorNgoc Nguyen
Laboratory Phone(909) 620-4602
Laboratory LocationWalmart Pharmacy #10-228880 Rio Rancho Rd, Pomona, CA 91766
CLIA data matches this NPI record on: Address Name
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.
48 services46 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.
40 services38 patients

Medical Equipment Supplier Medicare DMEPOS 11

Medicare supplier enrollment and the product categories Wal-Mart Pharmacy 10-2288 carries, from the Medicare DMEPOS supplier directory.

Wal-Mart Pharmacy 10-2288

DMEPOS supplier · Pomona, CAOperated by Walmart Inc
⋮

Does not accept Medicare assignment

Wal-Mart Pharmacy 10-2288 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)20427245
Medicare Participant SinceJanuary 1, 2019
Supplier Location80 Rio Rancho RdPomona, CA 91766
Phone(909) 620-4077
Supplier Specialties
Pharmacy Optician

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
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
Blood Glucose Monitors/Supplies (Non-Mail Order)
Home blood glucose monitors including lancets, reagent strips, and other supplies necessary for the proper functioning of the device
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 7

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

SARAH T. PHAN
Pharmacist
80 RIO RANCHO RD
POMONA, CA 91766
Los Angeles County (909) 620-4077
KATEE QUACH OD INC
Optometrist
80 RIO RANCHO RD
POMONA, CA 91766
Los Angeles County (909) 397-9866
RICKY CHAN
Pharmacist
80 RIO RANCHO RD
POMONA, CA 91766
Los Angeles County (909) 620-4077
DR. JUDITH Y PARK PHARM.D.
Pharmacist
80 RIO RANCHO RD
POMONA, CA 91766
Los Angeles County (909) 620-4077
NATIONAL VISION, INC.
Eyewear Supplier
80 RIO RANCHO RD
POMONA, CA 91766
Los Angeles County (909) 397-9700
FIRSTSIGHT VISION SERVICES, INC,
Optometrist
80 RIO RANCHO RD
POMONA, CA 91766
Los Angeles County (909) 397-9866
WALMART, INC.
Technician/Technologist (Optician)
80 RIO RANCHO RD
POMONA, CA 91766
Los Angeles County (909) 397-9700

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 1205853553. It was assigned to this organization in the NPPES registry on July 16, 2006. The provider is doing business as Walmart Pharmacy 10-2288.

Where is Walmart Inc. located?

Walmart Inc. is located at 80 Rio Rancho Rd, Pomona, CA 91766. The listed phone number is (909) 620-4077.

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 10-2288 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 05D2340712) is associated with this NPI, valid through March 19, 2028. 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 September 29, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.