Wal-Mart Stores East LP
Organization Active NPI Community/Retail Pharmacy · Walnut, MS
NPI 1124427455 · NPPES record last updated Dec 29, 2015
Key facts
- NPI
- 1124427455
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 13614/ 1.2 (MS)
- Legal business name
- WAL-MART STORES EAST LP
- Practice address
- 28191 Highway 15
Walnut, MS 38683-9798 - Phone
- (662) 223-5242
- NPI assigned
- Aug 22, 2014
- Organization subpart
- No
Authorized official
- Name
- Laura Levine
- Title
- Dir Healthcare Contr
- Phone
- (479) 204-8550
Member of 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130913000150 | MS | Part B Supplier - Mass Immunization (Roster Biller Only) | 6204749997 |
This NPI is an additional NPI on the enrollment Practice locations: Canton, MS; Yazoo City, MS; Tupelo, MS; Starkville, MS; Ocean Springs, MS; Diberville, MS; Corinth, MS; Biloxi, MS… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | 13614/ 1.2 | MS | Yes |
Addresses
Primary practice location
28191 Highway 15
Walnut, MS 38683-9798
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 204-8705
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2147555 | Other | PK | |
| 03174871 | Medicaid | MS |
Other names
- Walmart Pharmacy 10-3866
Other providers in Walnut, MS
- North Mississippi Primary Health Care, Inc.
- Jessica Gail Prather
- Rhonda M. Taylor
- Tippah County Hospital
- Treesap Clinic, Inc.
- Manuel Alexandro Zuniga
All providers in Walnut, MS · Community/Retail Pharmacy in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 29, 2015. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.