Wal-Mart Stores East LP
Organization Active NPI Community/Retail Pharmacy · Louisville, KY
NPI 1346267671 · NPPES record last updated Jun 2, 2025
Key facts
- NPI
- 1346267671
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- P06459 (KY)
- Legal business name
- WAL-MART STORES EAST LP
- Practice address
- 11901 Standiford Plaza Dr
Louisville, KY 40229-5906 - Phone
- (502) 968-6766
- NPI assigned
- Jul 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Kimberly Canonic
- Title
- Senior Director, Enrollment
- Phone
- (480) 277-6348
Corporate family (same tax ID) 24
Member of 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930046929 | KY | DME Supplier - Pharmacy |
6204749997 | Practice locations: Louisville, KY |
| O20130807000885 | KY | Part B Supplier - Mass Immunization (Roster Biller Only) | 6204749997 | This NPI is an additional NPI on the enrollment |
| O20220901001467 | KY | Part B Supplier - Independent Clinical Laboratory | 6204749997 | This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Ability Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | P06459 | KY | Yes |
Addresses
Primary practice location
11901 Standiford Plaza Dr
Louisville, KY 40229-5906
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5403465700 | Medicaid | KY | |
| 2033075 | Other | PK | |
| 5401004600 | Medicaid | KY |
Other names
- WALMART PHARMACY 100589
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 Louisville, KY
- Wakefields Home Health & Improvement
- Wal-Mart Stores East LP
- Wal-Mart Stores East LP
- Wal-Mart Stores East LP
- Wal-Mart Stores East LP
- Wal-Mart Stores East LP
- Wal-Mart Stores East LP
- Wal-Mart Stores East LP
- Wal-Mart Stores East LP
- Wal-Mart Stores East LP
All providers in Louisville, KY · Community/Retail Pharmacy in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 2, 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.