Wal-Mart Stores East LP
Organization Active NPI Community/Retail Pharmacy · Unicoi, TN
NPI 1851333090 · NPPES record last updated Jul 8, 2025
Key facts
- NPI
- 1851333090
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 4278 (TN)
- Legal business name
- WAL-MART STORES EAST LP
- Practice address
- 110 Rocky Bottom Dr
Unicoi, TN 37692-4030 - Phone
- (423) 743-9998
- Fax
- (423) 743-8087
- NPI assigned
- Jun 12, 2006
- Organization subpart
- No
Authorized official
- Name
- Kimberly Canonic
- Title
- Senior Director Enrolment
- Phone
- (480) 853-0515
Corporate family (same tax ID) 24
Member of 2
Practitioners 2
-
Charles Wade Workman II, D.PH.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Walmart Pharmacy 10-3852 |
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 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930062090 | TN | DME Supplier - Pharmacy | 6204749997 | Practice locations: Unicoi, TN |
| O20130808000651 | TN | 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 | |||
| Community/Retail Pharmacy | 3336C0003X | 4278 | TN | Yes |
Addresses
Primary practice location
110 Rocky Bottom Dr
Unicoi, TN 37692-4030
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 204-8550
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 466406 | Medicaid | TN | |
| 2095012 | Other | PK |
Other names
- WAL-MART PHARMACY 10-3852
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other |
Other providers in Unicoi, TN
- Cynthia Karen Reece
- Brian Arthur Rovira
- Southland Health Services
- Debra Troutman
- Unicoi County Medical Services Inc
- Charles Wade Workman II
All providers in Unicoi, TN · Community/Retail Pharmacy in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2025. 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.