Wal-Mart Stores Texas LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

29532 Issued in TX

Legal business name

WAL-MART STORES TEXAS LLC

Doing business as

Walmart Pharmacy 10-2779

Practice address

5 N 14TH St
Haskell, TX 79521-3106

Phone

(940) 864-8085

Fax

(940) 864-8087

NPI assigned

Dec 4, 2014

Last updated

Apr 15, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Laura Levine

Title

Dr. Healthcare & Enrollment

Phone

(479) 204-8550

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Walmart Pharmacy 10-2779 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Walmart Inc.

  dba Walmart Pharmacy 10-2422

  • Community/Retail Pharmacy
  • Saint Helens, OR
  • NPI 1962429019

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1417651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429056000000",
    "number": "1033516117",
    "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": "479-277-2500",
            "fax_number": "479-277-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 N 14TH ST",
            "city": "HASKELL",
            "state": "TX",
            "postal_code": "795213106",
            "telephone_number": "940-864-8085",
            "fax_number": "940-864-8087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES TEXAS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-04",
        "last_updated": "2015-04-15",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "DR. HEALTHCARE & ENROLLMENT",
        "authorized_official_telephone_number": "479-204-8550"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "29532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2149230",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "467109",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walmart Pharmacy 10-2779",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Philip Jason Smith, FNP
• Jason Stewart
• Kristi Kay Stewart, LPC
• Kathleen Tanner, CCC/SLP
• Charles M Thomas, PTA
• Scott Daniel Woodard, P.T.
• Joe Allen Yates, F.N.P.

• Community/Retail Pharmacy in Haskell, TX
• Providers in Haskell, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2015; 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.