Wal-Mart Stores East LP
Organization Active NPI Community/Retail Pharmacy · N Smithfield, RI
NPI 1639196884 · NPPES record last updated Jun 5, 2025
Key facts
- NPI
- 1639196884
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHA00541 (RI)
- Legal business name
- WAL-MART STORES EAST LP
- Practice address
- 7 Dowling Village Blvd
N Smithfield, RI 02896-8266 - Phone
- (401) 769-1695
- NPI assigned
- Jul 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Kimberly Canonic
- Title
- Senior Director, Enrollment
- Phone
- (480) 277-6348
Other NPIs on the same Medicare enrollment 8
Corporate family (same tax ID) 8
Member of 2
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Wal-Mart Stores East LP |
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|Enteral Nutrients|Surgical Dressings | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in RI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930041479 | RI | DME Supplier - Pharmacy | 6204749997 | Practice locations: N Smithfield, RI |
| O20130925000432 | RI | Part B Supplier - Mass Immunization (Roster Biller Only) | 6204749997 |
8 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Coventry, RI; Cranston, RI; N Smithfield, RI; Newport, RI; North Kingstown, RI; Providence, RI; Warwick, RI; Westerly, RI |
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 | PHA00541 | RI | Yes |
Addresses
Primary practice location
7 Dowling Village Blvd
N Smithfield, RI 02896-8266
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| WM10873 | Medicaid | RI | |
| 2088936 | Other | PK |
Other names
- WAL-MART PHARMACY 10-2225
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 N Smithfield, RI
- Northern Rhode Island Medical Group
- Nri Medical Services, Incorporated
- Rhode Island CVS Pharmacy, L.L.C.
- Rhode Island Physical Therapy and Sports Medicine Inc
- Stop and Shop Supermarket Co LLC
All providers in N Smithfield, RI · Community/Retail Pharmacy in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 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.