NPIMap

Wal-Mart Stores East LP

Organization Active NPI Community/Retail Pharmacy · Richmond, VA

NPI 1376560482 · NPPES record last updated Jun 25, 2024

Key facts

NPI
1376560482
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
0201003677 (VA)
Legal business name
WAL-MART STORES EAST LP
Practice address
2410 Sheila LN
Richmond, VA 23225-2041
Phone
(804) 320-0099
Fax
(804) 320-0099
NPI assigned
Jul 16, 2006
Organization subpart
No

Authorized official

Name
Matt McMullin
Title
Director of Healthcare Contracting
Phone
(479) 371-8711

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2116834Wal-Mart Stores East, LP
2410 Sheila Lane, Richmond, VA 23225		Certificate of waiverAug 1, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Wal-Mart Stores East, LP
2410 Sheila LN, Richmond, VA 23225-2040 · (804) 320-0099		 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Ostomy Supplies|Prosthetic Lenses: Conventional Eyeglasses|Enteral Nutrients|Surgical Dressings Does not accept assignment
Participating since Jul 1, 2014

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in VA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100930005048 VA DME Supplier - Pharmacy
DME Supplier - Optician		 6204749997 Practice locations: Richmond, 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 (4,651 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 0201003677 VA Yes
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

2410 Sheila LN
Richmond, VA 23225-2041

Mailing address

702 SW 8TH St
Bentonville, AR 72716-0445

Other identifiers

IdentifierTypeStateIssuer
8508097MedicaidVA
008508097MedicaidVA
2104695OtherPK

Other names

  • WAL-MART PHARMACY 10-2821 Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Other providers in Richmond, VA

All providers in Richmond, VA · Community/Retail Pharmacy in Virginia

Sources for this page

Verify at the official NPI Registry.