Active NPI
Wal-Mart Stores, Inc.
Doing business as Wal-Mart Pharmacy
- Community/Retail Pharmacy
- Bottineau, ND
National Provider Identifier
1104002534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- WAL-MART STORES, INC.
- Doing business as
- Wal-Mart Pharmacy
- Practice address
- 912 11TH Street East
Bottineau, ND 58318 - Phone
- (701) 228-5930
- NPI assigned
- Jan 16, 2008
- Last updated
- Feb 6, 2009
- Organization subpart
- Yes
- Parent organization
- WAL-MART STORES INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dianna Painter
- Title
- TP Enrollment Specialist
- Phone
- (479) 277-1238
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | NU | Primary |
Addresses
Primary practice location
912 11TH Street East
Bottineau, ND 58318
Mailing address
Mail Stop 0445
702 SW 8TH St
Bentonville, AR 72716
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3504481 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER |
Other names 1
- WAL-MART PHARMACY
National Provider Directory
National Provider Directory- Tax ID family
- Ability Network
- Part of
- Walmart Pharmacy 10-206
Organizations with this tax ID in the same state 12
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
dba Wal-Mart Pharmacy 10-2033
- Community/Retail Pharmacy
- Mandan, ND
- NPI 1285073486
-
dba Wal-Mart Vision Center 30-1695
- Eyewear Supplier
- Devils Lake, ND
- NPI 1508283730
Locations
912 11th St E
Bottineau, ND 58318
Phone (701) 228-5930
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200441600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1233878400000",
"number": "1104002534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "MAIL STOP 0445",
"address_2": "702 SW 8TH ST",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "72716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "912 11TH STREET EAST",
"city": "BOTTINEAU",
"state": "ND",
"postal_code": "58318",
"telephone_number": "701-228-5930"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WAL-MART STORES, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WAL-MART STORES INC",
"enumeration_date": "2008-01-16",
"last_updated": "2009-02-06",
"status": "A",
"authorized_official_last_name": "PAINTER",
"authorized_official_first_name": "DIANNA",
"authorized_official_title_or_position": "TP ENROLLMENT SPECIALIST",
"authorized_official_telephone_number": "479-277-1238"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
"identifier": "3504481",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "WAL-MART PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bottineau, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.