Active NPI
Wal-Mart Stores Inc
- Community/Retail Pharmacy
- Chicago, IL
National Provider Identifier
1760765606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 054017753
- Legal business name
- WAL-MART STORES INC
- Doing business as
- Wal-Mart Pharmacy
- Practice address
- 3636 N Broadway St
Chicago, IL 60613-4568 - Phone
- (773) 525-0962
- NPI assigned
- Sep 27, 2011
- Organization subpart
- Yes
- Parent organization
- WAL-MART STORES INC
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | 054017753 | IL | Primary |
Addresses
Primary practice location
3636 N Broadway St
Chicago, IL 60613-4568
Mailing address
702 SW 8TH St
Bentonville, AR 72716-6209
Phone (479) 277-1238
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2132103 | Other | PK |
Other names 1
- Wal-Mart Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130814000649 | IL | Part B Supplier - Mass Immunization (Roster Biller Only) | 4385556745 | This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Part of
- Walmart Pharmact
Locations
3636 N Broadway St
Chicago, IL 60613
Phone (773) 281-3370
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317081600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1406246400000",
"number": "1760765606",
"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": "3636 N BROADWAY ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606134568",
"telephone_number": "773-525-0962"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WAL-MART STORES INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WAL-MART STORES INC",
"enumeration_date": "2011-09-27",
"last_updated": "2014-07-25",
"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": "IL",
"license": "054017753",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2132103",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Wal-Mart Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 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.