NPIMap

Organization Active NPI

Wal-Mart Stores East LP

Doing business as Walmart Pharmacy 10-3635

  • Community/Retail Pharmacy
  • Fort Oglethorpe, GA
National Provider Identifier
1902200827
Registry record updated Aug 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHRE010113 Issued in GA
Legal business name
WAL-MART STORES EAST LP
Doing business as
Walmart Pharmacy 10-3635
Practice address
1155 Battlefield Pkwy
Fort Oglethorpe, GA 30742-3960
Phone
(762) 887-6046
NPI assigned
Oct 21, 2014
Last updated
Aug 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2023

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

Authorized official

Name
Sarah Little
Title
Director of Healthcare Contracting
Phone
(479) 277-2500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Community/Retail Pharmacy 3336C0003X PHRE010113 GA Primary

Addresses

Primary practice location

1155 Battlefield Pkwy
Fort Oglethorpe, GA 30742-3960

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
2148791OtherPK
003155952AMedicaidGA

Other names 1

  • Walmart Pharmacy 10-3635 Doing business as

Electronic endpoints 1

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140910000822 GA Part B Supplier - Mass Immunization (Roster Biller Only) 6204749997 Receives reassigned benefits from 2 practitioners
This NPI is an additional NPI on the enrollment
O20150509000114 GA DME Supplier - Pharmacy 6204749997 Practice locations: Fort Oglethorpe, GA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2174917Walmart Pharmacy 10-36351155 Battlefield Parkway, Fort Oglethorpe, GA 30742Certificate of waiverNov 11, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Walmart Pharmacy 10-36351155 Battlefield Pkwy, Fort Oglethorpe, GA 30742-3960(762) 887-6046 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 assignmentParticipating since Jul 1, 2014

National Provider Directory

National Provider Directory
Tax ID family
Ability Network4,654 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Member of 2

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

  • Sams East Inc

    dba Sams Pharmacy 10-8256

    • Community/Retail Pharmacy
    • Knoxville, TN
    • NPI 1265459465

    Member Of

    NPD member
  • Walmart Inc.

    dba Walmart Pharmacy 10-1588

    • Community/Retail Pharmacy
    • Victorville, CA
    • NPI 1043237456

    Member Of

    NPD member

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1413849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692662400000",
    "number": "1902200827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SW 8TH ST",
            "address_2": "MAILSTOP 0445",
            "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": "1155 BATTLEFIELD PKWY",
            "city": "FORT OGLETHORPE",
            "state": "GA",
            "postal_code": "307423960",
            "telephone_number": "762-887-6046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES EAST LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-21",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A",
        "authorized_official_last_name": "LITTLE",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "DIRECTOR OF HEALTHCARE CONTRACTING",
        "authorized_official_telephone_number": "479-277-2500"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE010113",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2148791",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003155952A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Walmart Pharmacy 10-3635",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Walmart Pharmacy 10-3635",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Oglethorpe, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.