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WALMART INC.
NPI 1689912594
Pharmacy - Community/Retail Pharmacy in South Jordan, UT

Active since January 28, 2013CLIA 46D2138982 · Waiver
3590 W SOUTH JORDAN PKWY, SOUTH JORDAN, UT 84095(801) 601-3119 Get Directions Write a Review

NPPES record last updated: June 16, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 16, 2025, Jul 19, 2018, Feb 26, 2018 and 2 more (5 updates tracked since 2015).

About Walmart Inc. NPPES

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

WALMART INC. (NPI 1689912594), doing business as Walmart Pharmacy 10-5763, is a healthcare organization registered as a community/retail pharmacy in South Jordan, Utah and active in the NPI registry since January 2013. The organization holds a CLIA Waiver certificate valid through October 26, 2027 and lists Kimberly Canonic, Senior Director, Enrollment, as its authorized official.

NPPES Registry Identity

NPI1689912594
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameWALMART INC.
Location Address3590 W SOUTH JORDAN PKWYSouth Jordan, UT 84095-8916
Mailing Address702 Sw 8th StBentonville, AR 72716
Phone(801) 601-3119
Organization SubpartNo
Authorized OfficialKimberly CanonicSenior Director, Enrollment · (480) 853-0515
Enumeration DateJanuary 28, 2013
Last NPPES UpdateJune 16, 20255 updates tracked since enumeration
NPPES CertifiedJune 16, 2025
✔ NPI 1689912594 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 UT · 8528037-1703
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
3590 W SOUTH JORDAN PKWY, South Jordan, UT 84095
Open in Google Maps ↗

Other Names 1

Doing Business AsWalmart Pharmacy 10-5763

Other Identifiers 1

Other2138832Pk

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 46D2138982

Walmart Pharmacy 10-5763 · S Jordan, UT
Active · expires Oct 26, 2027
CLIA Number46D2138982
Laboratory TypePharmacy
Certificate Effective DateOctober 27, 2025
Certificate Expiration DateOctober 26, 2027
Laboratory DirectorBrent K. Hiramoto
Laboratory Phone(801) 601-3119
Laboratory LocationWalmart Pharmacy 10-57633590 W South Jordan Pkwy, S Jordan, UT 84095
CLIA data matches this NPI record on: 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.

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.
200 services198 patients
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.
200 services198 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 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.
21 services21 patients

Medical Equipment Supplier Medicare DMEPOS 12

Medicare supplier enrollment and the product categories Walmart Pharmacy 10-5763 carries, from the Medicare DMEPOS supplier directory.

Walmart Pharmacy 10-5763

DMEPOS supplier · South Jordan, UTOperated by Walmart Inc
⋮

Does not accept Medicare assignment

Walmart Pharmacy 10-5763 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)20441903
Medicare Participant SinceJanuary 1, 2019
Supplier Location3590 W South Jordan PkwySouth Jordan, UT 84095
Phone(801) 601-3119
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
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 6

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

KYLE CRUTCHER PHARMD
Pharmacist
3590 W SOUTH JORDAN PKWY
SOUTH JORDAN, UT 84095
Salt Lake County (801) 601-3119
SLC WALMART EYE DOCS
Optometrist
3590 W SOUTH JORDAN PKWY
SOUTH JORDAN, UT 84095
Salt Lake County (801) 601-3131
HAZAEL SHERARD FINKENTHAL PHARMD
Pharmacist
3590 W SOUTH JORDAN PKWY
SOUTH JORDAN, UT 84095
Salt Lake County (801) 601-3119
WAL-MART STORES, INC
Eyewear Supplier
3590 W SOUTH JORDAN PKWY
SOUTH JORDAN, UT 84095
Salt Lake County (479) 258-2115
NICOLE CROCKETT RPH
Pharmacist
3590 W SOUTH JORDAN PKWY
SOUTH JORDAN, UT 84095
Salt Lake County (801) 601-3119
BRENT HIRAMOTO RPH
Pharmacist
3590 W SOUTH JORDAN PKWY
SOUTH JORDAN, UT 84095
Salt Lake County (801) 601-3119

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 1689912594. It was assigned to this organization in the NPPES registry on January 28, 2013. The provider is doing business as WalMart Pharmacy 10-5763.

Where is Walmart Inc. located?

Walmart Inc. is located at 3590 W South Jordan Pkwy, South Jordan, UT 84095. The listed phone number is (801) 601-3119.

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, Walmart Pharmacy 10-5763 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 46D2138982) is associated with this NPI, valid through October 26, 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 51 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 16, 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.