Active NPI
Wal-Mart Stores East LP
- Community/Retail Pharmacy
- Bedford, OH
National Provider Identifier
1801072244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 021791250
- Legal business name
- WAL-MART STORES EAST LP
- Practice address
- 22209 Rockside Rd
Bedford, OH 44146-1554 - Phone
- (216) 587-0100
- NPI assigned
- Jan 16, 2008
- 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 | 021791250 | OH | Primary |
Addresses
Primary practice location
22209 Rockside Rd
Bedford, OH 44146-1554
Mailing address
22209 Rockside Rd
Bedford, OH 44146-1554
Phone (216) 587-0110
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2081105 | Other | PK |
Other names 1
- WAL-MART PHARMACY 10-4342
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131203001976 | OH | Part B Supplier - Mass Immunization (Roster Biller Only) | 6204749997 | This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Part of
- Walmart Pharmact
Member of 2
Organizations this organization is a member of, according to the National Provider Directory.
Locations
22209 Rockside Rd
Bedford, OH 44146
Phone (216) 587-0100
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200441600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1386633600000",
"number": "1801072244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22209 ROCKSIDE RD",
"city": "BEDFORD",
"state": "OH",
"postal_code": "441461554",
"telephone_number": "216-587-0110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22209 ROCKSIDE RD",
"city": "BEDFORD",
"state": "OH",
"postal_code": "441461554",
"telephone_number": "216-587-0100"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WAL-MART STORES EAST LP",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WAL-MART STORES INC",
"enumeration_date": "2008-01-16",
"last_updated": "2013-12-10",
"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": "OH",
"license": "021791250",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2081105",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "WAL-MART PHARMACY 10-4342",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bedford, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2013; 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.