Wal-Mart Stores East LP
Organization Active NPI Community/Retail Pharmacy · Eureka, MO
NPI 1598782856 · NPPES record last updated May 29, 2025
Key facts
- NPI
- 1598782856
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 2002009509 (MO)
- Legal business name
- WAL-MART STORES EAST LP
- Practice address
- 131 Eureka Towne Center Dr
Eureka, MO 63025-1031 - Phone
- (636) 938-9425
- Fax
- (636) 938-6041
- NPI assigned
- Jul 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Kimberly Canonic
- Title
- Senior Director, Enrollment
- Phone
- (480) 277-6348
Corporate family (same tax ID) 24
Member of 2
Practitioners 5
-
Jenny Thao Vo, RPH
-
Jennifer Decker, PHARM D.
-
Jacob Sullivan Krebs, PHARM.D
-
Shima Patel, PHARM. D.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Walmart Pharmacy #10-0295 |
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 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930016989 | MO | DME Supplier - Pharmacy |
6204749997 | Practice locations: Eureka, MO |
| O20131102000102 | MO | 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
Locations
131 Eureka Towne Center Dr
Eureka, MO 63025
Phone (636) 587-9775
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 2002009509 | MO | Yes |
Addresses
Primary practice location
131 Eureka Towne Center Dr
Eureka, MO 63025-1031
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2051393 | Other | PK | |
| 603020009 | Medicaid | MO |
Other names
- WALMART PHARMACY 10-0295
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Direct | Ability Network |
Other providers in Eureka, MO
- Anjani Janak Urban
- Katherine Valenti
- Teodoro C. Vargas
- Wendy Velicer
- Vision Corp Inc
- Wal-Mart Stores East, LP
- Walgreen Co
- Carly Diane Walker
- Serena Lisa Walker
- Bonnie Waller
All providers in Eureka, MO · Community/Retail Pharmacy in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2025. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.