WALMART INC
NPI 1255865853
Pharmacy in Collinsville, IL

Q: What is Walmart Inc's NPI number?

The NPI number for Walmart Inc is 1255865853. It was assigned to this organization in the NPPES registry on April 20, 2017. The provider is also known as Walmart Pharmacy 10-2425.

Q: What is Walmart Inc's specialty?

The primary specialty registered for this NPI is Pharmacy with taxonomy code 333600000X.

Q: When was this NPI record last updated?

The NPPES record for Walmart Inc was last updated on June 12, 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.

Active since April 20, 2017CLIA 14D2128612 · Waiver

1101 BELT LINE RD, COLLINSVILLE, IL 62234(618) 381-7556(618) 381-7555 Get Directions Write a Review

NPPES record last updated: June 12, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 12, 2025, Jun 1, 2017, Apr 20, 2017 (3 updates tracked since 2017).

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About Walmart Inc NPPES

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

WALMART INC (NPI 1255865853) is a healthcare organization registered as a pharmacy in Collinsville, Illinois and active in the NPI registry since April 2017. The organization holds a CLIA Waiver certificate valid through April 2, 2027 and lists Kimberly Canonic, Senior Director, Enrollment, as its authorized official.

NPPES Registry Identity

NPI1255865853

Entity TypeOrganization

Primary Taxonomy333600000X

Legal Business NameWALMART INC

Location Address1101 BELT LINE RDCollinsville, IL 62234-4368

Mailing Address702 Sw 8th StBentonville, AR 72716-0445 · (479) 204-1258 · Fax (479) 277-4331

Phone(618) 381-7556

Fax(618) 381-7555

Organization SubpartNo

Authorized OfficialKimberly CanonicSenior Director, Enrollment · (480) 853-0515

Enumeration DateApril 20, 2017

Last NPPES UpdateJune 12, 20253 updates tracked since enumeration

NPPES CertifiedJune 12, 2025

✔ NPI 1255865853 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacySuppliers

Taxonomy Code333600000X

Definition

A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X

Also ListedPharmacy · Community/Retail PharmacyTaxonomy 3336C0003X

1101 BELT LINE RD, Collinsville, IL 62234

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Other Names 1

Other NameWalmart Pharmacy 10-2425

Other Identifiers 1

Other2169401Pk

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 14D2128612

Walmart Pharmacy #10-2425 · Collinsville, IL

Active · expires Apr 2, 2027

CLIA Number14D2128612

Laboratory TypePharmacy

Certificate Effective DateApril 3, 2025

Certificate Expiration DateApril 2, 2027

Laboratory DirectorRuiying Zhang

Laboratory Phone(618) 381-7556

Laboratory LocationWalmart Pharmacy #10-24251101 Belt Line Rd, Collinsville, IL 62234

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.

191 services191 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.

173 services173 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.

24 services24 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.

17 services17 patients

Other Providers at the Same Location NPPES 5

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

ZACHARY A RAINES PHARMD

Pharmacist