NPIMap

Wal-Mart Stores East LP

Organization Active NPI Community/Retail Pharmacy · Fayetteville, NC

NPI 1114306602 · NPPES record last updated Aug 29, 2023

Key facts

NPI
1114306602
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
12643 (NC)
Legal business name
WAL-MART STORES EAST LP
Practice address
8660 Cliffdale Rd
Fayetteville, NC 28314-5858
Phone
(479) 277-2795
Fax
(479) 277-4331
NPI assigned
May 29, 2015
Organization subpart
No

Authorized official

Name
Sarah Little
Title
Director of Healthcare Contracting
Phone
(479) 277-2500

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Member of 2

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

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2097308Walmart Pharmacy 10-3411
8660 Cliffdale Road, Fayetteville, NC 28314		Certificate of waiverJun 11, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Walmart Pharmacy 10-3411
8660 Cliffdale Rd, Fayetteville, NC 28314-5858 · (910) 213-1409		 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Ostomy Supplies|Enteral Nutrients|Surgical Dressings Does not accept assignment
Participating since Jul 1, 2014

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in NC

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20130724000619 NC Part B Supplier - Mass Immunization (Roster Biller Only) 6204749997 This NPI is an additional NPI on the enrollment
O20151008001483 NC DME Supplier - Pharmacy 6204749997 Practice locations: Fayetteville, NC

National Provider Directory

Tax ID family
Ability Network (4,651 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X 12643 NC Yes

Addresses

Primary practice location

8660 Cliffdale Rd
Fayetteville, NC 28314-5858

Mailing address

702 SW 8TH St
Bentonville, AR 72716-6209
Phone (479) 277-2795

Other identifiers

IdentifierTypeStateIssuer
1114306602MedicaidNC
2153058OtherPK

Other names

  • Walmart Pharmacy 10-3411 Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Other providers in Fayetteville, NC

All providers in Fayetteville, NC · Community/Retail Pharmacy in North Carolina

Sources for this page

Verify at the official NPI Registry.