Wal-Mart Stores East LP

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

114431 Issued in AL

Legal business name

WAL-MART STORES EAST LP

Doing business as

Wal-Mart Pharmacy 10-2235

Practice address

6361 Highway 72 East
Gurley, AL 35748

Phone

(256) 776-4404

Fax

(479) 277-4331

NPI assigned

Aug 21, 2014

Last updated

Feb 2, 2015By 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

Laura Levine

Title

Dir Healthcare Contract&Enroll

Phone

(479) 204-8550

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Wal-Mart Pharmacy 10-2235 Doing business as

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

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

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

{
    "created_epoch": "1408579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422835200000",
    "number": "1730588104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SW 8TH ST",
            "address_2": "MAILSTOP 0445",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445",
            "telephone_number": "479-277-2500",
            "fax_number": "479-277-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6361 HIGHWAY 72 EAST",
            "city": "GURLEY",
            "state": "AL",
            "postal_code": "35748",
            "telephone_number": "256-776-4404",
            "fax_number": "479-277-4331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES EAST LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-21",
        "last_updated": "2015-02-02",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "DIR HEALTHCARE CONTRACT&ENROLL",
        "authorized_official_telephone_number": "479-204-8550"
    },
    "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": "AL",
            "license": "114431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167487",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2147623",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wal-Mart Pharmacy 10-2235",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vallaree Gail Prentice, NP
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• Matika Thomas, PHARM D
• Eve Shepherd Welte, M.S., CCC-SLP
• Megan Kate West, LICSW

• Community/Retail Pharmacy in Gurley, AL
• Providers in Gurley, AL by specialty
• Community/Retail Pharmacy in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2015; 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.