NPIMap

Wal-Mart Stores East LP

Organization Active NPI Community/Retail Pharmacy · Halifax, MA

NPI 1831116144 · NPPES record last updated Jun 3, 2025

Key facts

NPI
1831116144
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
DS89686 (MA)
Legal business name
WAL-MART STORES EAST LP
Practice address
295 Plymouth St
Halifax, MA 02338-1340
Phone
(781) 294-7001
NPI assigned
Jul 16, 2006
Organization subpart
No

Authorized official

Name
Kimberly Canonic
Title
Senior Director, Enrollment
Phone
(480) 277-6348

Other NPIs on the same Medicare enrollment 47

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 47

Corporate family (same tax ID) 21

Organizations that report the same tax identification number in the National Provider Directory.

Member of 2

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Wal-Mart Pharmacy 10-2128
295 Plymouth St, Halifax, MA 02338-1340 · (781) 294-7001		 Epoetin|Immunosuppressive Drugs|Infusion 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
Participating since Jul 1, 2014

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100930087315 MA DME Supplier - Pharmacy 6204749997 Practice locations: Halifax, MA
O20150115002399 MA Part B Supplier - Mass Immunization (Roster Biller Only) 6204749997 48 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Northampton, MA; Northborough, MA; Orange, MA; Pittsfield, MA; Plymouth, MA; Quincy, MA; Raynham, MA; Salem, MA…

National Provider Directory

Tax ID family
Ability Network (4,651 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X DS89686 MA Yes

Addresses

Primary practice location

295 Plymouth St
Halifax, MA 02338-1340

Mailing address

702 SW 8TH St
Bentonville, AR 72716-0445

Other identifiers

IdentifierTypeStateIssuer
0447188MedicaidMA
447188MedicaidMA
2038385OtherPK

Other names

  • WAL-MART PHARMACY 10-2128 Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Other providers in Halifax, MA

All providers in Halifax, MA · Community/Retail Pharmacy in Massachusetts

Sources for this page

Verify at the official NPI Registry.