Wal-Mart Stores East LP

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

13591/ 1.2 Issued in MS

Legal business name

WAL-MART STORES EAST LP

Doing business as

Walmart Pharmacy 10-3856

Practice address

410 2ND St
Belmont, MS 38827-7700

Phone

(662) 454-0301

Fax

(662) 454-0303

NPI assigned

Aug 22, 2014

Last updated

Dec 29, 2015By the provider in NPPES

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 10-3856 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

  dba Sams Pharmacy

  • Community/Retail Pharmacy
  • San Antonio, TX
  • NPI 1932126059

  Member Of

  NPD member
• Walmart Inc.

  dba Walmart Pharmacy 10-2050

  • Community/Retail Pharmacy
  • Henderson, NV
  • NPI 1043237142

  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": "1451347200000",
    "number": "1851790182",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 2ND ST",
            "city": "BELMONT",
            "state": "MS",
            "postal_code": "388277700",
            "telephone_number": "662-454-0301",
            "fax_number": "662-454-0303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES EAST LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-22",
        "last_updated": "2015-12-29",
        "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": "13591/ 1.2",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07624241",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2147534",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walmart Pharmacy 10-3856",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Whitney Bonner Sparks, NP
• Square Pharmacy and Gifts of Belmont, LLC
• Michael Paul Stamper, OTR/L
• Tishomingo Health Services, Inc. (Belmont Family Medical Clinic)
• Tishomingo Regional Providers
• Chelsea Wells, FNP
• Alexa Sparks White, PTA
• Kristie Whitehead, FNP
• Yarber Drug Store Inc

• Community/Retail Pharmacy in Belmont, MS
• Providers in Belmont, MS by specialty
• Community/Retail Pharmacy in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 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.