Wal-Mart Stores Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PDO.1680000038 Issued in CO

Legal business name

WAL-MART STORES INC

Practice address

2253 S Monaco Pkwy
Denver, CO 80222-5813

Phone

(303) 323-4416

Fax

(303) 323-4410

NPI assigned

Jul 15, 2013

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 Gov. Contracting

Phone

(479) 204-8550

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Wal-Mart Pharmacy 10-3021 Doing business as

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Part of

Walmart Pharmact

Locations

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

{
    "created_epoch": "1373846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447113600000",
    "number": "1134560451",
    "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": "727160445",
            "telephone_number": "479-204-8741",
            "fax_number": "479-277-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2253 S MONACO PKWY",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802225813",
            "telephone_number": "303-323-4416",
            "fax_number": "303-323-4410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAL-MART STORES INC",
        "enumeration_date": "2013-07-15",
        "last_updated": "2015-11-10",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "MGR OF GOV. 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": "CO",
            "license": "PDO.1680000038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2141214",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wal-Mart Pharmacy 10-3021",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Harold1 R Wakefield, M.D.
• Leo Ken Wakefield
• Meredith Elizabeth Wakelyn, LCSW
• Yusuke Wakeshima, MD
• Anisa Marie Wakil, MD
• Wal-Mart Stores, Inc.
• Wal-Mart Stores, Inc.
• Diana Walbrun, MSW,CSW,CCM
• Arthur S Waldbaum, MD
• Denise D Walden, RN, BSN

• Community/Retail Pharmacy in Denver, CO
• Providers in Denver, CO by specialty
• Community/Retail Pharmacy in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2015; 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.