NPIMap

Wal-Mart Stores East LP

Organization Active NPI Community/Retail Pharmacy · Methuen, MA

NPI 1194742403 · NPPES record last updated Jun 19, 2025

Key facts

NPI
1194742403
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
DS3072 (MA)
Legal business name
WAL-MART STORES EAST LP
Practice address
70 Pleasant Valley St
Methuen, MA 01844-7288
Phone
(978) 686-3359
NPI assigned
Jul 16, 2006
Organization subpart
No

Authorized official

Name
Kimberly Canonic
Title
Senior Director, Enrollment
Phone
(480) 853-0515

Other NPIs on the same Medicare enrollment 47

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 47

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Member of 2

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

Practitioners 2

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

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Wal-Mart Stores East LP
70 Pleasant Valley St, Methuen, MA 01844-7288 · (978) 686-3359		 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Ostomy Supplies|Enteral Nutrients|Surgical Dressings Does not accept assignment
Participating since Jul 1, 2014

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100930079860 MA DME Supplier - Pharmacy 6204749997 Practice locations: Methuen, MA
O20150115002399 MA Part B Supplier - Mass Immunization (Roster Biller Only) 6204749997 48 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Northampton, MA; Northborough, MA; Orange, MA; Pittsfield, MA; Plymouth, MA; Quincy, MA; Raynham, MA; Salem, MA…

National Provider Directory

Tax ID family
Ability Network (4,651 organizations share this tax ID)

Locations

70 Pleasant Valley St
Methuen, MA 01844
Phone (978) 686-3359

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X DS3072 MA Yes

Addresses

Primary practice location

70 Pleasant Valley St
Methuen, MA 01844-7288

Mailing address

702 SW 8TH St
Bentonville, AR 72716-0445

Other identifiers

IdentifierTypeStateIssuer
404136MedicaidMA
0404136MedicaidMA
2038918OtherPK

Other names

  • WAL-MART PHARMACY 10-3491 Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Other providers in Methuen, MA

All providers in Methuen, MA · Community/Retail Pharmacy in Massachusetts

Sources for this page

Verify at the official NPI Registry.