Wal-Mart Stores Texas LLC
Organization Active NPI Community/Retail Pharmacy · Atlanta, TX
NPI 1124045372 · NPPES record last updated Dec 1, 2023
Key facts
- NPI
- 1124045372
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 21771 (TX)
- Legal business name
- WAL-MART STORES TEXAS LLC
- Practice address
- 201 US Highway 59 Loop
Atlanta, TX 75551-2011 - Phone
- (903) 796-8231
- NPI assigned
- Jul 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Matthew McMullin
- Title
- Director, Contracting
- Phone
- (479) 371-8711
Corporate family (same tax ID) 24
Member of 1
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Walmart Pharmacy 10-0226 |
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|Prosthetic Lenses: Conventional Eyeglasses|Enteral Nutrients|Surgical Dressings | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930085175 | TX | DME Supplier - Pharmacy | 7719199165 | Practice locations: Atlanta, TX |
| O20130611000245 | TX | Part B Supplier - Mass Immunization (Roster Biller Only) | 7719199165 | This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Wal-Mart Stores Teas LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 21771 | TX | Yes |
Addresses
Primary practice location
201 US Highway 59 Loop
Atlanta, TX 75551-2011
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 277-1238
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2096777 | Other | PK | |
| 468780 | Medicaid | TX |
Other names
- WALMART PHARMACY 100226
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Other providers in Atlanta, TX
- Total Renal Care Inc
- Robert Terry Trawnik
- Rosharon Shunta Turner
- Kayla Underwood
- Jennifer Wagner
- Wal-Mart Stores Texas, LP
- Scott A Walls
- Wesley Partners, LTD.
- White Cat, Inc
- Regina Whitehorn
All providers in Atlanta, TX · Community/Retail Pharmacy in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.