NPIMap

Organization Active NPI

Wal-Mart Stores East LP

  • Community/Retail Pharmacy
  • Wewoka, OK
National Provider Identifier
1881091965
Registry record updated May 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
24-6876 Issued in OK
Legal business name
WAL-MART STORES EAST LP
Practice address
2325 Seran
Wewoka, OK 74884-5098
Phone
(405) 257-6566
Fax
(405) 257-6730
NPI assigned
Dec 4, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Laura Levine
Title
Dr. Healthcare & Enrollment
Phone
(479) 204-8550

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X 24-6876 OK Primary

Addresses

Primary practice location

2325 Seran
Wewoka, OK 74884-5098

Mailing address

702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 277-2500

Other identifiers 2

IdentifierTypeStateIssuer
100231610 UMedicaidOK
2149233OtherPK

Other names 1

  • Walmart Pharmacy 10-3766 Doing business as

National Provider Directory

National Provider Directory

Member of 2

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

Locations

2325 Seran
Wewoka, OK 74884
Phone (405) 257-6566

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1417651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430870400000",
    "number": "1881091965",
    "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",
            "telephone_number": "479-277-2500",
            "fax_number": "479-277-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2325 SERAN",
            "city": "WEWOKA",
            "state": "OK",
            "postal_code": "748845098",
            "telephone_number": "405-257-6566",
            "fax_number": "405-257-6730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES EAST LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-04",
        "last_updated": "2015-05-06",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "DR. HEALTHCARE & ENROLLMENT",
        "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": "OK",
            "license": "24-6876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100231610 U",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2149233",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walmart Pharmacy 10-3766",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wewoka, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.