Wal-Mart Stores East LP
Organization Active NPI Community/Retail Pharmacy · Woodsville, NH
NPI 1710163159 · NPPES record last updated Jul 10, 2025
Key facts
- NPI
- 1710163159
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 0745P (NH)
- Legal business name
- WAL-MART STORES EAST LP
- Practice address
- 4901 Dartmouth College Hwy
Woodsville, NH 03785-1412 - Phone
- (603) 747-8250
- NPI assigned
- Jan 16, 2008
- Organization subpart
- No
Authorized official
- Name
- Kimberly Canonic
- Title
- Senior Director, Enrollment
- Phone
- (480) 853-0515
Other NPIs on the same Medicare enrollment 25
Corporate family (same tax ID) 24
Member of 2
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 30D2156119 | Walmart Pharmacy 10-4389 | Certificate of waiver | Oct 10, 2026 |
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 NH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930010238 | NH | DME Supplier - Pharmacy | 6204749997 | Practice locations: Woodsville, NH |
| O20131004000222 | NH | Part B Supplier - Mass Immunization (Roster Biller Only) | 6204749997 |
25 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Manchester, NH; North Conway, NH; Plaistow, NH; Plymouth, NH; Portsmouth, NH; Rindge, NH; Rochester, NH; Salem, NH… |
National Provider Directory
- Tax ID family
- Ability Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | 0745P | NH | Yes |
Addresses
Primary practice location
4901 Dartmouth College Hwy
Woodsville, NH 03785-1412
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 204-8550
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2053947 | Other | PK |
Other names
- WALMART PHARMACY 10-4389
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 Woodsville, NH
- Jack Sullivan
- The Alpine Clinc, PLLC
- Lisa Thompson
- Jessica Thornton-Sherman
- Mary Christine Valliant
- Kathryn S Walsh
- William S Holmes
- David Andrew Wood
- Woodsville Fire District
- Sarah Young-Xu
All providers in Woodsville, NH · Community/Retail Pharmacy in New Hampshire
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 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.