Wal-Mart Stores East LP
Organization Active NPI Community/Retail Pharmacy · Sumiton, AL
NPI 1447277751 · NPPES record last updated Aug 29, 2023
Key facts
- NPI
- 1447277751
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 111573 (AL)
- Legal business name
- WAL-MART STORES EAST LP
- Practice address
- 690 Highway 78
Sumiton, AL 35148-3419 - Phone
- (205) 648-1968
- 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 (2 enrollments) in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930042120 | AL | DME Supplier - Pharmacy |
6204749997 | Practice locations: Sumiton, AL |
| O20130807000603 | AL | 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 111573 | AL | Yes |
Addresses
Primary practice location
690 Highway 78
Sumiton, AL 35148-3419
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100003323 | Medicaid | AL | |
| 1994527 | Other | PK |
Other names
- WAL-MART PHARMACY 10-2723
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 Sumiton, AL
- Summit Physical Therapy LLC
- Lisbeth Caroline Thornley
- Tortomasi and Cole Partnership, DMD
- Anthony Joseph Tortomasi
- Verus Healthcare, LLC
- Wal-Mart Stores East, LP
- Walgreen Co
- Meredith S Wilson
All providers in Sumiton, AL · Community/Retail Pharmacy in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2023. 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.