Active NPI
Wal-Mart Stores East LP
- Community/Retail Pharmacy
- Norwalk, CT
National Provider Identifier
1508883893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PCY.0001833
- Legal business name
- WAL-MART STORES EAST LP
- Practice address
- 680 Connecticut Ave
Norwalk, CT 06854-1616 - Phone
- (203) 854-8519
- NPI assigned
- Jul 16, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kimberly Canonic
- Title
- Senior Director, Enrollment
- Phone
- (480) 277-6348
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PCY.0001833 | CT | Primary |
Addresses
Primary practice location
680 Connecticut Ave
Norwalk, CT 06854-1616
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 277-1242
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008047183 | Medicaid | CT | |
| 2002507 | Other | PK | |
| 004231148 | Medicaid | CT |
Other names 1
- WAL-MART PHARMACY 10-3547
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131226000547 | CT | Part B Supplier - Mass Immunization (Roster Biller Only) | 6204749997 |
33 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: New Milford, CT; North Windham, CT; Norwalk, CT; Norwich, CT; Old Saybrook, CT; Putnam, CT; Rocky Hill, CT; Shelton, CT… |
Other NPIs on the same Medicare enrollment 32
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryMember of 2
Organizations this organization is a member of, according to the National Provider Directory.
Locations
680 Connecticut Ave
#10
Norwalk, CT 06854
Phone (203) 854-8519
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153008000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1751328000000",
"number": "1508883893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "702 SW 8TH ST",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727160445",
"telephone_number": "479-277-1242"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "680 CONNECTICUT AVE",
"city": "NORWALK",
"state": "CT",
"postal_code": "068541616",
"telephone_number": "203-854-8519"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WAL-MART STORES EAST LP",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-16",
"last_updated": "2025-07-01",
"certification_date": "2025-07-01",
"status": "A",
"authorized_official_last_name": "CANONIC",
"authorized_official_first_name": "KIMBERLY",
"authorized_official_title_or_position": "SENIOR DIRECTOR, ENROLLMENT",
"authorized_official_telephone_number": "480-277-6348"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "CT",
"license": "PCY.0001833",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008047183",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2002507",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004231148",
"state": "CT"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.667.2",
"affiliationName": "Ability Network",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "100 N 6th St Ste 900A",
"city": "Minneapolis",
"state": "MN",
"country_code": "US",
"postal_code": "554031516",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "WAL-MART PHARMACY 10-3547",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Norwalk, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.