NPIMap

Organization Active NPI

Wal-Mart Stores Inc

Doing business as Wal-Mart Pharmacy 10-3814

  • Community/Retail Pharmacy
  • Juneau, AK
National Provider Identifier
1629277108
Registry record updated Jul 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
440 Issued in AK
Legal business name
WAL-MART STORES INC
Doing business as
Wal-Mart Pharmacy 10-3814
Practice address
6525 Glacier Hwy
Juneau, AK 99801-7905
Phone
(907) 789-2440
NPI assigned
Jul 13, 2007
Last updated
Jul 9, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
WAL-MART STORES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 9, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Laura Levine
Title
MGR of Government Contracting
Phone
(479) 204-8550

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Community/Retail Pharmacy 3336C0003X 440 AK Primary

Addresses

Primary practice location

6525 Glacier Hwy
Juneau, AK 99801-7905

Mailing address

702 SW 8TH St
Bentonville, AR 72716-0445

Other identifiers 3

IdentifierTypeStateIssuer
MS0256DMEMedicaidAK
1997072OtherPK
PH5147MedicaidAK

Other names 1

  • WAL-MART PHARMACY 10-3814 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130808000548 AK Part B Supplier - Mass Immunization (Roster Biller Only) 4385556745 9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kodiak, AK; Wasilla, AK; Ketchikan, AK; Kenai, AK; Fairbanks, AK; Eagle River, AK; Anchorage, AK

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Part of
Walmart Pharmacy 10-206

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373328000000",
    "number": "1629277108",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6525 GLACIER HWY",
            "city": "JUNEAU",
            "state": "AK",
            "postal_code": "998017905",
            "telephone_number": "907-789-2440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAL-MART STORES INC",
        "enumeration_date": "2007-07-13",
        "last_updated": "2013-07-09",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "MGR OF GOVERNMENT CONTRACTING",
        "authorized_official_telephone_number": "479-204-8550"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AK",
            "license": "440",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MS0256DME",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1997072",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PH5147",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WAL-MART PHARMACY 10-3814",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Juneau, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2013; 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.

Verify at the official NPI Registry.