WALMART PHARMACY 10-0765 – Community/Retail Pharmacy, NPI 1730106964

WALMART PHARMACY 10-0765 is a healthcare provider. based in San antonio, Texas. specializing in Community/Retail Pharmacy. The organization holds a License No. 21719 (TX). The NPI Number for WALMART PHARMACY 10-0765 is 1730106964

Main info

Organization
Name
WALMART PHARMACY 10-0765
NPI
1730106964
Phone
(210) 650-0647
Address
16503 NACOGDOCHES RD
Authorized Official
KIMBERLY CANONIC SENIOR DIRECTOR, ENROLLMENT
Enumeration Date
16 July 2006
Last Update Date
3 June 2025
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience72
Completeness80
Years active:19State licenses:1Digital endpointsUpdated within 12 months

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Provider Addresses for WALMART PHARMACY 10-0765

  • Nacogdoches Road, San Antonio, Bexar County, Texas, 78266, United States

    SAN ANTONIO, TX 782471010

    Phone: (210) 650-0647

    Type: Location

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

    BENTONVILLE, AR 727160445

    Phone: (479) 277-1238

    Fax: (479) 277-4331

    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 (832 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
O20100930022922OPharmacyTX2024-02-29

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 count67078$0
G0008Administration of influenza virus vaccine123123$0
90662Influenza vaccine split virus, preservative free116116$0
90480Admn sarscov2 vacc 1 dose5050$0
91322Sarscov2 vac 50 mcg/0.5ml im2525$0
View full utilization report →

Insurance plans in this area (ZIP 78247)

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Reviews

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Frequently asked questions

Can I cross-check WALMART PHARMACY 10-0765 using NPI 1730106964?
NPI 1730106964 belongs to WALMART PHARMACY 10-0765; compare other details if you need extra assurance.
Would WALMART PHARMACY 10-0765 appear as active to a payer?
You can treat WALMART PHARMACY 10-0765 as active for directory purposes; confirm clinical privileges separately.
What expertise is attributed to WALMART PHARMACY 10-0765?
WALMART PHARMACY 10-0765's specialty line reads Community/Retail Pharmacy. Clinical services aligned with this taxonomy classification.
What locale is associated with WALMART PHARMACY 10-0765?
Directory geography for WALMART PHARMACY 10-0765 centers on San Antonio, Texas.
Does WALMART PHARMACY 10-0765 accept insurance?
Insurance participation is not part of the core NPI extract — call the plan or office to confirm.

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