Wal-Mart Stores East LP

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

9166-42 Issued in WI

Legal business name

WAL-MART STORES EAST LP

Doing business as

Wal-Mart Pharmacy 10-3031

Practice address

N88W15559 Main St
Menomonee Falls, WI 53051-3156

Phone

(262) 509-5708

NPI assigned

Sep 4, 2012

Organization subpart

Yes

Parent organization

WAL-MART STORES INCAs reported in NPPES

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

Authorized official

Name

Laura Levine

Title

MGR of Government Contracting

Phone

(479) 204-8550

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Wal-Mart Pharmacy 10-3031 Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Part of

Walmart Pharmact

Member of 2

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

• Sams East Inc

  • Community/Retail Pharmacy
  • Hudson, NH
  • NPI 1982621009

  Member Of

  NPD member
• Walmart Inc.

  • Community/Retail Pharmacy
  • Pearl City, HI
  • NPI 1174541650

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1346716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395792000000",
    "number": "1134478332",
    "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": "727166209",
            "telephone_number": "479-277-1238",
            "fax_number": "479-277-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N88W15559 MAIN ST",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530513156",
            "telephone_number": "262-509-5708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES EAST LP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAL-MART STORES INC",
        "enumeration_date": "2012-09-04",
        "last_updated": "2014-03-26",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "MGR OF GOVERNMENT CONTRACTING",
        "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": "WI",
            "license": "9166-42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2136758",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wal-Mart Pharmacy 10-3031",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Davorka Vucetic, M.D.
• Jenna Waara
• Adriane Elaine Wade, RN
• Lauryn Wagner
• Stephanie Wahlen, OT
• Walgreen Co
• Walgreen Co
• Casey Walter, DPT
• Margaret (Peg) A Wanta, PT
• Sophia D Warner, PT

• Community/Retail Pharmacy in Menomonee Falls, WI
• Providers in Menomonee Falls, WI by specialty
• Community/Retail Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2014; 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.