WALMART PHARMACY 10-0556 – Community/Retail Pharmacy, NPI 1760409171

WALMART PHARMACY 10-0556 is a healthcare provider. based in Waycross, Georgia. specializing in Community/Retail Pharmacy. The organization holds a License No. PHRE007380 (GA). The NPI Number for WALMART PHARMACY 10-0556 is 1760409171

Main info

Organization
Name
WALMART PHARMACY 10-0556
NPI
1760409171
Phone
(912) 285-3939
Address
2425 MEMORIAL DR
Authorized Official
KIMBERLY CANONIC SENIOR DIRECTOR, ENROLLMENT
Enumeration Date
16 July 2006
Last Update Date
2 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 10-0556

  • Walmart Supercenter, 2425, Memorial Drive, Waycross, Ware County, Georgia, 31503, United States

    WAYCROSS, GA 315036337

    Phone: (912) 285-3939

    Type: Location

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

    BENTONVILLE, AR 727160445

    Phone:

    Type: Mailing

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 2024-02-29 (834 days ago).

Enrollment records

1

Earliest due date

2024-02-29

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
O20100930059675OPharmacyGA2024-02-29

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 count31237$0
G0008Administration of influenza virus vaccine9190$0
90662Influenza vaccine split virus, preservative free8382$0
91322Sarscov2 vac 50 mcg/0.5ml im3737$0
90480Admn sarscov2 vacc 1 dose3737$0
View full utilization report →

Insurance plans in this area (ZIP 31503)

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Reviews

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Frequently asked questions

What is the 10-digit NPI for WALMART PHARMACY 10-0556?
WALMART PHARMACY 10-0556 — NPI 1760409171 — is the standard way to identify this listing.
Is WALMART PHARMACY 10-0556 listed as active for patients and plans?
The listing shows WALMART PHARMACY 10-0556 as active in the NPI system.
What taxonomy line describes WALMART PHARMACY 10-0556?
For research purposes, treat WALMART PHARMACY 10-0556 as Community/Retail Pharmacy in this dataset. Clinical services aligned with this taxonomy classification.
What area does WALMART PHARMACY 10-0556 serve?
WALMART PHARMACY 10-0556's listing highlights Waycross, Georgia; more addresses can appear in NPPES.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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