Wal-Mart Stores East LP
Organization Active NPI Community/Retail Pharmacy · London, KY
NPI 1366469785 · NPPES record last updated Feb 16, 2017
Key facts
- NPI
- 1366469785
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PO2043 (KY)
- Legal business name
- WAL-MART STORES EAST LP
- Practice address
- 1851 Highway 192 W
London, KY 40741-3032 - Phone
- (606) 878-6143
- NPI assigned
- Jul 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Sarah Little
- Title
- Director of Healthcare Contracting
- Phone
- (479) 277-2500
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 |
|---|---|---|---|---|
| O20100930095655 | KY | DME Supplier - Pharmacy |
6204749997 | Practice locations: London, 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 | PO2043 | KY | Yes |
Addresses
Primary practice location
1851 Highway 192 W
London, KY 40741-3032
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2030692 | Other | PK | |
| 5400659800 | Medicaid | KY | |
| 5402233000 | Medicaid | KY |
Other names
- WALMART PHARMACY 10-1113
Other providers in London, KY
- Benjamin Vice
- Hazelee Vice
- Bridgett Wagers
- Nikki Wagers
- Wesley Wagers
- Wal-Mart Stores East, LP
- Cassandra Elizabeth Walden
- Elizabeth Sue Walden
- Sydni Walden
- Walgreen Co
All providers in London, 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 Feb 16, 2017. 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.