Wal-Mart Stores Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

51527 Issued in CA

Legal business name

WAL-MART STORES INC

Doing business as

Wal-Mart Pharmacy 10-4173

Practice address

12120 Carson St
Hawaiian Gardens, CA 90716-1108

Phone

(562) 384-4063

NPI assigned

Jun 4, 2013

Organization subpart

No

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

Authorized official

Name

Laura Levine

Title

Manager of Government Contract

Phone

(479) 204-8550

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wal-Mart Pharmacy 10-4173 Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Weiqin Fang

  • Pharmacist
  • Hawaiian Gardens, CA
  • NPI 1285042960
  NPD (past)

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

{
    "created_epoch": "1370304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412553600000",
    "number": "1174960843",
    "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": "479-273-4885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12120 CARSON ST",
            "city": "HAWAIIAN GARDENS",
            "state": "CA",
            "postal_code": "907161108",
            "telephone_number": "562-384-4063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-04",
        "last_updated": "2014-10-06",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "MANAGER OF GOVERNMENT CONTRACT",
        "authorized_official_telephone_number": "479-204-8550"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "51527",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2140679",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wal-Mart Pharmacy 10-4173",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cynthia Marie Trosino, PT
• Two Wings Health Services, Inc.
• Margarita Valadez
• Veronica Velasquez
• Vista Hospital of South Bay, LP
• Brianna Ware
• West Ocean Marketing & Development
• Wilson Healthcare, Inc Dba Hawaiian House
• Cuiyao Wu, ACSW
• Yaming Shi MD Inc.

• Community/Retail Pharmacy in Hawaiian Gardens, CA
• Providers in Hawaiian Gardens, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 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.