NPIMap

Organization Active NPI

Wal-Mart Stores Inc

Doing business as Wal-Mart Pharmacy 10-3097

  • Community/Retail Pharmacy
  • Portland, OR
National Provider Identifier
1023352812
Registry record updated Mar 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
RP-0002757-CS Issued in OR
Legal business name
WAL-MART STORES INC
Doing business as
Wal-Mart Pharmacy 10-3097
Practice address
8235 SW Apple Way
Portland, OR 97225-1782
Phone
(503) 205-9977
NPI assigned
Nov 16, 2012
Last updated
Mar 26, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
WAL-MART STORES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 26, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Laura Levine
Title
Manager Govt Contracting
Phone
(479) 204-8550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X RP-0002757-CS OR Primary

Addresses

Primary practice location

8235 SW Apple Way
Portland, OR 97225-1782

Mailing address

702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 204-0709

Other identifiers 1

IdentifierTypeStateIssuer
2138044OtherPK

Other names 1

  • Wal-Mart Pharmacy 10-3097 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151105000564 OR Part B Supplier - Mass Immunization (Roster Biller Only) 4385556745 46 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: McMinnville, OR; Milwaukie, OR; Medford, OR; Newport, OR; Ontario, OR; Pendleton, OR; Portland, OR; Redmond, OR…

Other NPIs on the same Medicare enrollment 44

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 44

National Provider Directory

National Provider Directory
Part of
Walmart Pharmacy 10-206

Locations

8235 SW Apple Way
Portland, OR 97225
Phone (503) 205-9977

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1353024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395792000000",
    "number": "1023352812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SW 8TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445",
            "telephone_number": "479-204-0709",
            "fax_number": "479-277-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8235 SW APPLE WAY",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972251782",
            "telephone_number": "503-205-9977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAL-MART STORES INC",
        "enumeration_date": "2012-11-16",
        "last_updated": "2014-03-26",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "MANAGER GOVT CONTRACTING",
        "authorized_official_telephone_number": "479-204-8550"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OR",
            "license": "RP-0002757-CS",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2138044",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wal-Mart Pharmacy 10-3097",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.