Wal-Mart Stores Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY 51215 Issued in CA

Legal business name

WAL-MART STORES INC

Practice address

701 W Cesar E Chavez Ave
Los Angeles, CA 90012-2104

Phone

(213) 337-0182

Fax

(213) 337-0174

NPI assigned

Mar 7, 2013

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

David Badeen

Title

Sr Dir H&W Billing, Recon

Phone

(479) 277-2611

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wal-Mart Pharmacy 10-3086 Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Part of

Walmart Pharmact

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

{
    "created_epoch": "1362614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395792000000",
    "number": "1972844405",
    "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": "479-204-8741",
            "fax_number": "479-277-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 W CESAR E CHAVEZ AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900122104",
            "telephone_number": "213-337-0182",
            "fax_number": "213-337-0174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAL-MART STORES INC",
        "enumeration_date": "2013-03-07",
        "last_updated": "2014-03-26",
        "status": "A",
        "authorized_official_last_name": "BADEEN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "SR DIR H&W BILLING, RECON",
        "authorized_official_telephone_number": "479-277-2611"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY 51215",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2139318",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wal-Mart Pharmacy 10-3086",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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
• Danielle Marguerite Waldby, AMFT/APCC

• 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 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.