NPIMap

Wal-Mart Stores East LP

Organization Active NPI Community/Retail Pharmacy · Gorham, NH

NPI 1528085644 · NPPES record last updated Aug 28, 2023

Key facts

NPI
1528085644
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
0536P (NH)
Legal business name
WAL-MART STORES EAST LP
Practice address
561 Main St
Gorham, NH 03581-4901
Phone
(603) 752-7330
NPI assigned
Jul 16, 2006
Organization subpart
No

Authorized official

Name
Sarah Little
Title
Director of Healthcare Contracting
Phone
(479) 277-2500

Other NPIs on the same Medicare enrollment 25

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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 2

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Wal-Mart Stores East LP
561 Main St, Gorham, NH 03581-4901 · (603) 752-7330		 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 NH

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100930081719 NH DME Supplier - Pharmacy
DME Supplier - Optician		 6204749997 Practice locations: Gorham, NH
O20131004000222 NH Part B Supplier - Mass Immunization (Roster Biller Only) 6204749997 25 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Manchester, NH; North Conway, NH; Plaistow, NH; Plymouth, NH; Portsmouth, NH; Rindge, NH; Rochester, NH; Salem, NH…

National Provider Directory

Tax ID family
Ability Network (4,651 organizations share this tax ID)

Locations

491 Main St
Gorham, NH 03581

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 0536P NH Yes

Addresses

Primary practice location

561 Main St
Gorham, NH 03581-4901

Mailing address

702 SW 8TH St
Bentonville, AR 72716-0445

Other identifiers

IdentifierTypeStateIssuer
2053489OtherPK
30702062MedicaidNH

Other names

  • WAL-MART PHARMACY 10-2634 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 Gorham, NH

All providers in Gorham, NH · Community/Retail Pharmacy in New Hampshire

Sources for this page

Verify at the official NPI Registry.