Wal-Mart Stores Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY46196 Issued in CA

Legal business name

WAL-MART STORES INC

Practice address

4101 Crenshaw Blvd
Los Angeles, CA 90008-2501

Phone

(323) 299-8246

NPI assigned

Jul 16, 2006

Organization subpart

Yes

Parent organization

WAL-MART STORES INCAs reported in NPPES

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

Authorized official

Name

Laura Levine

Title

MGR of Government Contracting

Phone

(479) 204-8550

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• WAL-MART PHARMACY 10-2960 Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Part of

Walmart Pharmact

Locations

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377561600000",
    "number": "1932126299",
    "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": "4101 CRENSHAW BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900082501",
            "telephone_number": "323-299-8246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAL-MART STORES INC",
        "enumeration_date": "2006-07-16",
        "last_updated": "2013-08-27",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "MGR OF GOVERNMENT 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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY46196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "463PHA461960",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1997751",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WAL-MART PHARMACY 10-2960",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeannie Wakamatsu, MPH, RD
• Tod Hitoshi Wakamatsu, DDS
• Emily Wakeling, AMFT
• Ali Wakil, MD
• Nicole Wakus
• Wal-Mart Stores Inc
• Richard A Walburg, DPM
• Jessica Leigh Walchonski, PA-C
• Noah Wald-Dickler, M.D.
• Jennifer Waldburger, LCSW

• Community/Retail Pharmacy in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2013; 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.