Wal-Mart Stores East, LP

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

13604/ 1.2 Issued in MS

Legal business name

WAL-MART STORES EAST, LP

Practice address

420 E Lee St
Sardis, MS 38666-1236

Phone

(662) 487-9001

Fax

(662) 487-9003

NPI assigned

Aug 22, 2014

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 Contracting

Phone

(479) 204-8550

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Walmart Pharmacy 10-3865 Doing business as

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Member of 2

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

• Sams East Inc

  • Community/Retail Pharmacy
  • Hudson, NH
  • NPI 1982621009

  Member Of

  NPD member
• Walmart Inc.

  • Community/Retail Pharmacy
  • Pearl City, HI
  • NPI 1174541650

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1408665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431993600000",
    "number": "1770982001",
    "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": "479-204-8705",
            "fax_number": "479-277-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 E LEE ST",
            "city": "SARDIS",
            "state": "MS",
            "postal_code": "386661236",
            "telephone_number": "662-487-9001",
            "fax_number": "662-487-9003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES EAST, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-22",
        "last_updated": "2015-05-19",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "DIR HEALTHCARE 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": "MS",
            "license": "13604/ 1.2",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2147561",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09785548",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walmart Pharmacy 10-3865",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• SFMC Laboratory
• Beverly Jean Shead, LPN
• Timberlake Transportation LLC
• Linda L Troy, FNP
• Jessica Tubbs
• Vicki Watson, RN
• Lance Dewey Whaley, MD

• All providers in Sardis, MS
• Community/Retail Pharmacy in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 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.