Active NPI
Wal-Mart Stores East LP
- Community/Retail Pharmacy
- Pikeville, NC
National Provider Identifier
1245574953
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 11422
- Legal business name
- WAL-MART STORES EAST LP
- Doing business as
- Wal-Mart Pharmacy 10-2573
- Practice address
- 303 Goldsboro St
Pikeville, NC 27863-9649 - Phone
- (919) 242-8718
- NPI assigned
- Nov 19, 2012
- Organization subpart
- Yes
- Parent organization
- WAL-MART STORES INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Laura Levine
- Title
- Manager, Govt Contracting
- Phone
- (479) 204-8550
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 11422 | NC | Primary |
Addresses
Primary practice location
303 Goldsboro St
Pikeville, NC 27863-9649
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 204-0709
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2138199 | Other | PK | |
| 1245574953 | Medicaid | NC |
Other names 1
- Wal-Mart Pharmacy 10-2573
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130724000619 | NC | Part B Supplier - Mass Immunization (Roster Biller Only) | 6204749997 | This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Part of
- Walmart Pharmact
Member of 2
Organizations this organization is a member of, according to the National Provider Directory.
Locations
303 Goldsboro St
Pikeville, NC 27863
Phone (919) 242-8718
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353283200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1387497600000",
"number": "1245574953",
"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": "303 GOLDSBORO ST",
"city": "PIKEVILLE",
"state": "NC",
"postal_code": "278639649",
"telephone_number": "919-242-8718"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WAL-MART STORES EAST LP",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WAL-MART STORES INC",
"enumeration_date": "2012-11-19",
"last_updated": "2013-12-20",
"status": "A",
"authorized_official_last_name": "LEVINE",
"authorized_official_first_name": "LAURA",
"authorized_official_title_or_position": "MANAGER, GOVT CONTRACTING",
"authorized_official_telephone_number": "479-204-8550"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NC",
"license": "11422",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2138199",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1245574953",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Wal-Mart Pharmacy 10-2573",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Pikeville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2013; 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.