Wal-Mart Stores Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054018102 Issued in IL

Legal business name

WAL-MART STORES INC

Doing business as

Walmart Pharmacy 10-2430

Practice address

1424 W 47TH St
Chicago, IL 60609-3232

Phone

(561) 509-2026

NPI assigned

Nov 19, 2012

Organization subpart

No

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

Authorized official

Name

Sarah Little

Title

Director of Healthcare Contracting

Phone

(479) 277-2500

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Walmart Pharmacy 10-2430 Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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

{
    "created_epoch": "1353283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487548800000",
    "number": "1164766846",
    "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": "479-204-0709",
            "fax_number": "479-277-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1424 W 47TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606093232",
            "telephone_number": "561-509-2026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-19",
        "last_updated": "2017-02-20",
        "status": "A",
        "authorized_official_last_name": "LITTLE",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "DIRECTOR OF HEALTHCARE CONTRACTING",
        "authorized_official_telephone_number": "479-277-2500"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054018102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2138033",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walmart Pharmacy 10-2430",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Karla Wakim, M.D.
• Pierre E Wakim, D.O.
• Lauren S. Wakschlag
• Renee Joanna Wakulski
• Lyla Wakut
• Wal-Mart Stores Inc (Wal-Mart Pharmacy)
• Wal-Mart Stores Inc (Wal-Mart Vision Center 30-5965)
• Wal-Mart Stores Inc (Wal-Mart Pharmacy)
• Wal-Mart Stores, Inc. (Vision Center 30-5402)
• Marna Simon Wal, LSW

• Community/Retail Pharmacy in Chicago, IL
• Providers in Chicago, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; 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.