Wal-Mart Stores East LP
Organization Active NPI Community/Retail Pharmacy · Gray Court, SC
NPI 1356745277 · NPPES record last updated May 20, 2015
Key facts
- NPI
- 1356745277
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 15587 (SC)
- Legal business name
- WAL-MART STORES EAST LP
- Practice address
- 9032 Highway 14
Gray Court, SC 29645-4151 - Phone
- (864) 876-1213
- NPI assigned
- Oct 21, 2014
- Organization subpart
- No
Authorized official
- Name
- Laura Levine
- Title
- Dr. Healthcare & Enrollment
- Phone
- (479) 204-8550
Member of 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20141110000939 | SC | Part B Supplier - Mass Immunization (Roster Biller Only) | 6204749997 | This NPI is an additional NPI on the enrollment |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | 15587 | SC | Yes |
Addresses
Primary practice location
9032 Highway 14
Gray Court, SC 29645-4151
Mailing address
702 SW 8TH St
Mailstop 0445
Bentonville, AR 72716-0445
Phone (479) 277-2500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2148896 | Other | PK |
Other names
- Walmart Pharmacy 10-1250
Other providers in Gray Court, SC
- Johnna Revis
- Sam Leake LLC
- Isaiah Simpson
- Spartanburg Medical Center
- Valor Medical Services,LLC
- Christie Webb
- Joy Wilson
- Zivitski Health Group LLC
All providers in Gray Court, SC · Community/Retail Pharmacy in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 20, 2015. 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.