NPIMap

Organization Active NPI

Wal-Mart Stores East LP

Doing business as Wal-mart Pharmacy

  • Community/Retail Pharmacy
  • Port Allen, LA
National Provider Identifier
1932200912
Registry record updated Jul 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
4788RC Issued in LA
Legal business name
WAL-MART STORES EAST LP
Doing business as
Wal-mart Pharmacy
Practice address
3255 La Highway 1 S
Port Allen, LA 70767-5858
Phone
(225) 749-7454
Fax
(225) 749-7418
NPI assigned
Sep 25, 2006
Last updated
Jul 3, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2008

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

Authorized official

Name
Randy Wright
Title
Phy Enrollment Specialist
Phone
(479) 273-6574

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 4788RC LA Primary

Addresses

Primary practice location

3255 La Highway 1 S
Port Allen, LA 70767-5858

Mailing address

702 SW 8TH St
Bentonville, AR 72716-6209

Other identifiers 2

IdentifierTypeStateIssuer
1923110OtherLANCPDP NUMBER
1269930MedicaidLA

Other names 1

  • Wal-mart Pharmacy Doing business as

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

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215043200000",
    "number": "1932200912",
    "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": "727166209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3255 LA HIGHWAY 1 S",
            "city": "PORT ALLEN",
            "state": "LA",
            "postal_code": "707675858",
            "telephone_number": "225-749-7454",
            "fax_number": "225-749-7418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES EAST LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2008-07-03",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "PHY ENROLLMENT SPECIALIST",
        "authorized_official_telephone_number": "479-273-6574"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "LA",
            "license": "4788RC",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "1923110",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1269930",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wal-mart Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Allen, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2008; 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.