Wal-Mart Stores East LP
Organization Active NPI Community/Retail Pharmacy · Spencer, IN
NPI 1831116136 · NPPES record last updated Aug 23, 2023
Key facts
- NPI
- 1831116136
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 60005031 (IN)
- Legal business name
- WAL-MART STORES EAST LP
- Practice address
- 823 W State Highway 46
Spencer, IN 47460-6748 - Phone
- (812) 829-2289
- NPI assigned
- Jul 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Sarah Little
- Title
- Director of Healthcare Contracting
- Phone
- (479) 277-2500
Corporate family (same tax ID) 24
Member of 2
Practitioners 1
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Wal-Mart Pharmacy 10-0996 |
Epoetin|Immunosuppressive 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 IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930031519 | IN | DME Supplier - Pharmacy | 6204749997 | Practice locations: Spencer, IN |
| O20130824000051 | IN | Part B Supplier - Mass Immunization (Roster Biller Only) | 6204749997 | This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Ability Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 60005031 | IN | Yes |
Addresses
Primary practice location
823 W State Highway 46
Spencer, IN 47460-6748
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100300200A | Medicaid | IN | |
| 2026420 | Other | PK | |
| 100300200 | Medicaid | IN |
Other names
- WAL-MART PHARMACY 10-0996
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 Spencer, IN
- Mary Jo Stine
- Transitional Services Sub, LLC
- Transitional Services, Inc
- Valley Optical, Inc.
- Sheila R Vanhook
- Walden Family Health Care LLC
- Dana Louise Walden
- Michelle Marie Webster
- Barbara Diane G Wells
- Lindsey Whaley
All providers in Spencer, IN · Community/Retail Pharmacy in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2023. 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.