Wal-Mart Stores East LP
Organization Active NPI Community/Retail Pharmacy · Newington, NH
NPI 1295754208 · NPPES record last updated May 30, 2025
Key facts
- NPI
- 1295754208
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 0595P (NH)
- Legal business name
- WAL-MART STORES EAST LP
- Practice address
- 2200 Woodbury Ave
Newington, NH 03801-2817 - Phone
- (603) 430-4427
- NPI assigned
- Jul 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Kimberly Canonic
- Title
- Senior Director, Enrollment
- Phone
- (480) 277-6348
Other NPIs on the same Medicare enrollment 25
Corporate family (same tax ID) 24
Member of 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930046401 | NH | DME Supplier - Pharmacy |
6204749997 | Practice locations: Newington, NH |
| O20131004000222 | NH | Part B Supplier - Mass Immunization (Roster Biller Only) | 6204749997 |
25 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Manchester, NH; North Conway, NH; Plaistow, NH; Plymouth, NH; Portsmouth, NH; Rindge, NH; Rochester, NH; Salem, NH… |
National Provider Directory
- Tax ID family
- Ability Network
Locations
2200 Woodbury Ave
Newington, NH 03801
Phone (603) 430-2183
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 0595P | NH | Yes |
Addresses
Primary practice location
2200 Woodbury Ave
Newington, NH 03801-2817
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2053532 | Other | PK | |
| 30702051 | Medicaid | NH |
Other names
- WAL-MART PHARMACY 10-2398
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Other providers in Newington, NH
- The Touch of Sunshine, LLC
- Tina Labarre Nutrition LLC
- Town of Newington NH
- Usv Optical Inc.
- Kate Vaillancourt
- Wal-Mart Stores East, LP
- Autumn Wallace
- Pamela J Ward
- Amber D Whitman
- Whole Life Health Care, PA
All providers in Newington, NH · Community/Retail Pharmacy in New Hampshire
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.