Wal-Mart Stores East LP

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2-5449 Issued in OK

Legal business name

WAL-MART STORES EAST LP

Doing business as

WalMart Pharmacy 10-4637

Practice address

3900 E Hillside Dr
Broken Arrow, OK 74014-6713

Phone

(918) 355-1076

NPI assigned

Jul 21, 2009

Last updated

Aug 29, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sarah Little

Title

Director of Healthcare Contracting

Phone

(479) 277-2500

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• WalMart Pharmacy 10-4637 Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Member of 2

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

• Sams East Inc

  dba Sams Pharmacy 10-8256

  • Community/Retail Pharmacy
  • Knoxville, TN
  • NPI 1265459465

  Member Of

  NPD member
• Walmart Inc.

  dba Walmart Pharmacy 10-1588

  • Community/Retail Pharmacy
  • Victorville, CA
  • NPI 1043237456

  Member Of

  NPD member

Locations

Practitioners 4

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.

• Jessica Lynn Cameron, PHARMD

  • Pharmacist
  • Broken Arrow, OK
  • NPI 1427834894
  NPD (past)
• Meagan Elise Hamilton

  • Pharmacist
  • Broken Arrow, OK
  • NPI 1598366122
  NPD (past)
• Ashlea Terann Herzfeld, PHARMD

  • Pharmacist
  • Broken Arrow, OK
  • NPI 1033721360
  NPD (past)
• Casey Logan Oberste, PHARMD, RPH

  • Pharmacist
  • Broken Arrow, OK
  • NPI 1982200507
  NPD (past)

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

{
    "created_epoch": "1248134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693267200000",
    "number": "1699905901",
    "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",
            "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": "3900 E HILLSIDE DR",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740146713",
            "telephone_number": "918-355-1076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES EAST LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-21",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A",
        "authorized_official_last_name": "LITTLE",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "DIRECTOR OF HEALTHCARE CONTRACTING",
        "authorized_official_telephone_number": "479-277-2500"
    },
    "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": "OK",
            "license": "2-5449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2121175",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100231610L",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "WalMart Pharmacy 10-4637",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WalMart Pharmacy 10-4637",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wal-Mart Stores East , LP (Walmart Pharmacy 10-4655)
• Wal-Mart Stores East , LP (Walmart Pharmacy 10-0472)
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0472)
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-3295)
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-3508)
• Teresa Lynn Waldrop Burnett, LCSW, MT-BC
• Ashley R Wale, MHR ,LPC
• Walgreen Co (Walgreens #07547)
• Walgreen Co (Walgreens #03040)
• Walgreen Co (Walgreens #03534)

• Community/Retail Pharmacy in Broken Arrow, OK
• Providers in Broken Arrow, OK by specialty
• Community/Retail Pharmacy in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.