Wal-Mart Stores Texas LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

28243 Issued in TX

Legal business name

WAL-MART STORES TEXAS LLC

Doing business as

Wal-Mart Pharmacy

Practice address

2218 Greenville Ave
Dallas, TX 75206-7122

Phone

(972) 581-0430

NPI assigned

May 31, 2012

Organization subpart

Yes

Parent organization

WAL-MART STORES INCAs reported in NPPES

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

Addresses

Other identifiers 2

Other names 1

• Wal-Mart Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Part of

Wal Mart Pharmacy 10 2039

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Walmart Inc.

  dba WalMart Pharmacy 10-4208

  • Community/Retail Pharmacy
  • Salt Lake City, UT
  • NPI 1326396300

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1338422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392854400000",
    "number": "1679834147",
    "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": "727166209",
            "telephone_number": "479-277-1238",
            "fax_number": "479-277-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2218 GREENVILLE AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752067122",
            "telephone_number": "972-581-0430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES TEXAS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAL-MART STORES INC",
        "enumeration_date": "2012-05-31",
        "last_updated": "2014-02-20",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "28243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679834147",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2135595",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wal-Mart Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-3406)
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-3015)
• Wal-Mart Stores Texas LLC (Wal-Mart Vision Center 30-5931)
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-5823)
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-8930)
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-2427)
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-5931)
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-3341)
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-2667)
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-5021)

• Community/Retail Pharmacy in Dallas, TX
• Providers in Dallas, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2014; 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.