Wal-Mart Stores East, LP
Organization Active NPI Pharmacy · Timberville, VA
NPI 1669820866 · NPPES record last updated Aug 23, 2023
Key facts
- NPI
- 1669820866
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 0201004715 (VA)
- Legal business name
- WAL-MART STORES EAST, LP
- Practice address
- 375 S Main St
Timberville, VA 22853-9522 - Phone
- (540) 896-0463
- NPI assigned
- May 27, 2016
- Organization subpart
- No
Authorized official
- Name
- Sarah Little
- Title
- Director of Healthcare Contracting
- Phone
- (479) 277-2500
Corporate family (same tax ID) 24
Member of 2
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 49D2114949 | Walmart Pharmacy 10-6952 | Certificate of waiver | Jun 23, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140606001173 | VA | Part B Supplier - Mass Immunization (Roster Biller Only) | 6204749997 | This NPI is an additional NPI on the enrollment |
| O20160928000540 | VA | DME Supplier - Pharmacy |
6204749997 | Practice locations: Timberville, VA |
National Provider Directory
- Tax ID family
- Ability Network
Locations
375 S Main St
Timberville, VA 22853
Phone (540) 704-7130
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 0201004715 | VA | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
375 S Main St
Timberville, VA 22853-9522
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 258-6180
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669820866 NPI | Medicaid | VA | |
| 2160453 | Other | PK |
Other names
- Walmart Pharmacy 10-6952
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 Timberville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2023. 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.