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WALMART INC.
NPI 1609293968
Pharmacy - Community/Retail Pharmacy in San Jose, CA

Active since March 25, 2014CLIA 05D2340305 · Waiver
4080 STEVENS CREEK BLVD, SAN JOSE, CA 95129(408) 556-4507(408) 556-4508 Get Directions Write a Review

NPPES record last updated: June 9, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jun 9, 2025, Jul 19, 2018, Feb 26, 2018 and 2 more (5 updates tracked since 2016).

About Walmart Inc. NPPES

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

WALMART INC. (NPI 1609293968), doing business as Walmart Pharmacy 10-2486, is a healthcare organization registered as a community/retail pharmacy in San Jose, California and active in the NPI registry since March 2014. The organization holds a CLIA Waiver certificate valid through March 15, 2028 and lists Kimberly Canonic, Senior Director, Enrollment, as its authorized official.

NPPES Registry Identity

NPI1609293968
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameWALMART INC.
Location Address4080 STEVENS CREEK BLVDSan Jose, CA 95129-1334
Mailing Address702 Sw 8th StBentonville, AR 72716-0445 · (479) 258-2115 · Fax (479) 277-4331
Phone(408) 556-4507
Fax(408) 556-4508
Organization SubpartNo
Authorized OfficialKimberly CanonicSenior Director, Enrollment · (480) 277-6348
Enumeration DateMarch 25, 2014
Last NPPES UpdateJune 9, 20255 updates tracked since enumeration
NPPES CertifiedJune 9, 2025
✔ NPI 1609293968 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in CA · 51785
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
4080 STEVENS CREEK BLVD, San Jose, CA 95129
Open in Google Maps ↗

Other Names 1

Doing Business AsWalmart Pharmacy 10-2486

Other Identifiers 2

Other2144935Pk
Medicaid1609293968CA

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 05D2340305

Walmart Pharmacy #10-2486 · San Jose, CA
Active · expires Mar 15, 2028
CLIA Number05D2340305
Laboratory TypePharmacy
Certificate Effective DateMarch 16, 2026
Certificate Expiration DateMarch 15, 2028
Laboratory DirectorKulkarni Suwarna
Laboratory Phone(408) 556-4505
Laboratory LocationWalmart Pharmacy #10-24864080 Stevens Creek Blvd, San Jose, CA 95129
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 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.
188 services188 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.
183 services183 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
Pneumococcal vaccine, 23-valent 90732
The 23-valent pneumococcal vaccine is an injection that helps protect against serious infections caused by 23 types of pneumococcal bacteria. It's vital for those at risk, like older adults or people with certain health conditions, to prevent pneumonia, meningitis, and bloodstream infections.
11 services11 patients

Medical Equipment Supplier Medicare DMEPOS 11

Medicare supplier enrollment and the product categories Wal-Mart Pharmacy 10-2486 carries, from the Medicare DMEPOS supplier directory.

Wal-Mart Pharmacy 10-2486

DMEPOS supplier · San Jose, CAOperated by Walmart Inc
⋮

Does not accept Medicare assignment

Wal-Mart Pharmacy 10-2486 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)20444345
Medicare Participant SinceJanuary 1, 2019
Supplier Location4080 Stevens Creek BlvdSan Jose, CA 95129
Phone(408) 556-4507
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.

SUWARNA KULKARNI
Pharmacist
4080 STEVENS CREEK BLVD
SAN JOSE, CA 95129
Santa Clara County (408) 556-4507
SUNYEON KIM
Pharmacist
4080 STEVENS CREEK BLVD
SAN JOSE, CA 95129
Santa Clara County (408) 556-4507
JASON D KWONG PHARM D
Pharmacist
4080 STEVENS CREEK BLVD
SAN JOSE, CA 95129
Santa Clara County (408) 556-4507

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 1609293968. It was assigned to this organization in the NPPES registry on March 25, 2014. The provider is doing business as WalMart Pharmacy 10-2486.

Where is Walmart Inc. located?

Walmart Inc. is located at 4080 Stevens Creek Blvd, San Jose, CA 95129. The listed phone number is (408) 556-4507.

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 10-2486 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 05D2340305) is associated with this NPI, valid through March 15, 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 June 9, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.