Wal-Mart Stores East LP

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

9127-42 Issued in WI

Legal business name

WAL-MART STORES EAST LP

Doing business as

Wal-Mart Pharmacy 10-3030

Practice address

3850 N 124TH St
Wauwatosa, WI 53222-2104

Phone

(414) 203-4367

NPI assigned

Apr 10, 2012

Last updated

Mar 26, 2014By the provider in NPPES

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 2

Addresses

Other identifiers 1

Other names 1

• Wal-Mart Pharmacy 10-3030 Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Part of

Walmart Pharmacy 10-206

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

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

{
    "created_epoch": "1334016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395792000000",
    "number": "1962768382",
    "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",
            "telephone_number": "479-277-1238",
            "fax_number": "479-277-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 N 124TH ST",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532222104",
            "telephone_number": "414-203-4367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES EAST LP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAL-MART STORES INC",
        "enumeration_date": "2012-04-10",
        "last_updated": "2014-03-26",
        "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "9127-42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2134721",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wal-Mart Pharmacy 10-3030",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Breanna M Vretenar
• John A Vukich, MD
• Terri Wagner, M.S., CCC-SLP
• Charles Jay Waisbren, MD
• Julie B Waisbren, MD
• Walgreen Co (Walgreens Specialty Pharmacy #21254)
• Walgreen Co (Walgreens #10196)
• Walgreen Co (Walgreens #03578)
• Walgreen Co (Walgreens #04095)
• Walgreen Co (Walgreens #04253)

• Community/Retail Pharmacy in Wauwatosa, WI
• Providers in Wauwatosa, WI by specialty
• Community/Retail Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2014; 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.