WALMART PHARMACY 10-0990 – Community/Retail Pharmacy, NPI 1124045331

WALMART PHARMACY 10-0990 is a healthcare provider. based in Bentonville, Arkansas. specializing in Community/Retail Pharmacy. The organization holds a License No. PH15369 (FL). The NPI Number for WALMART PHARMACY 10-0990 is 1124045331

Main info

Organization
Name
WALMART PHARMACY 10-0990
NPI
1124045331
Phone
(479) 277-1242
Address
702 SW 8TH ST
Authorized Official
KIMBERLY CANONIC SENIOR DIRECTOR, ENROLLMENT
Enumeration Date
16 July 2006
Last Update Date
4 June 2025

Contacts

Main Contact
https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience72
Completeness90
Years active:19State licenses:1Updated within 12 months

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Provider Addresses for WALMART PHARMACY 10-0990

  • Walmart Home Office Main Entrance, 702, Southwest 8th Street, Bentonville, Benton County, Arkansas, 72712, United States

    BENTONVILLE, AR 727166209

    Phone: (479) 277-1242

    Type: Mailing

  • Caroline Street, Pace, Santa Rosa County, Florida, 32571, United States

    PACE, FL 325711408

    Phone: (850) 995-5115

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2010-09-30

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Past revalidation due date

Earliest CMS due date was 2023-07-31 (1049 days ago).

Enrollment records

1

Earliest due date

2023-07-31

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
O20100930044242OPharmacyFL2023-07-31

What to do next

  • Verify current status on the CMS Revalidation Lookup Tool immediately.
  • Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
  • Overdue revalidation can lead to deactivation of Medicare billing privileges.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
K1034Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count29840$0
G0008Administration of influenza virus vaccine217216$0
90662Influenza vaccine split virus, preservative free206205$0
90480Admn sarscov2 vacc 1 dose6868$0
91322Sarscov2 vac 50 mcg/0.5ml im6767$0
View full utilization report →

Insurance plans in this area (ZIP 72716)

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Reviews

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Frequently asked questions

How is WALMART PHARMACY 10-0990 identified in CMS data?
CMS-hosted NPPES data lists WALMART PHARMACY 10-0990 with NPI 1124045331.
Does CMS list WALMART PHARMACY 10-0990 as active?
Yes — WALMART PHARMACY 10-0990 is active in the NPI listing used on this page.
What is WALMART PHARMACY 10-0990's primary classification?
Community/Retail Pharmacy is the headline specialty for WALMART PHARMACY 10-0990 here. Clinical services aligned with this taxonomy classification.
What address line appears for WALMART PHARMACY 10-0990?
WALMART PHARMACY 10-0990's geographic hint is Bentonville, Arkansas in our summary view.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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