Wal-Mart Stores East , LP
Organization Active NPI Community/Retail Pharmacy · South Hill, VA
NPI 1366469462 · NPPES record last updated Jun 10, 2025
Key facts
- NPI
- 1366469462
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 0201003130 (VA)
- Legal business name
- WAL-MART STORES EAST , LP
- Practice address
- 315 Furr St
South Hill, VA 23970-9500 - Phone
- (434) 447-2578
- 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
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 49D2146411 | Walmart Pharmacy 10-1934 | Certificate of waiver | Mar 27, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930044505 | VA | DME Supplier - Pharmacy |
6204749997 | Practice locations: South Hill, VA |
| O20140606001173 | VA | Part B Supplier - Mass Immunization (Roster Biller Only) | 6204749997 | This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Ability Network
Locations
1121 E Atlantic St
South Hill, VA 23970
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 0201003130 | VA | Yes |
Addresses
Primary practice location
315 Furr St
South Hill, VA 23970-9500
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008586586 | Medicaid | VA | |
| 8586586 | Medicaid | VA | |
| 2106097 | Other | PK |
Other names
- Walmart Pharmacy 10-1934
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 South Hill, VA
- Vaughan Medical Transport LLC
- Virginia CVS Pharmacy LLC
- Virginia Urology Center P C
- Vitacollect LLC
- W F & G, Inc
- Wal-Mart Stores East, LP
- Daniel Walbert
- Tammy Elaine Walters
- Margaret Carolyn Ward-Thompson
- Larry D Warren
All providers in South Hill, VA · Community/Retail Pharmacy in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.