Wal-Mart Stores East LP
Organization Active NPI Community/Retail Pharmacy · Grantsboro, NC
NPI 1972920577 · NPPES record last updated Jun 9, 2025
Key facts
- NPI
- 1972920577
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 11989 (NC)
- Legal business name
- WAL-MART STORES EAST LP
- Practice address
- 11233B NC 55 Hwy E
Grantsboro, NC 28529-9471 - Phone
- (252) 201-9012
- NPI assigned
- Mar 21, 2014
- Organization subpart
- No
Authorized official
- Name
- Kimberly Canonic
- Title
- Senior Director, Enrollment
- Phone
- (480) 277-6348
Corporate family (same tax ID) 17
Member of 2
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Walmart Pharmacy 10-7238 |
Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Canes and/or Crutches|Walkers|Ostomy Supplies|Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conve… | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130724000619 | NC | Part B Supplier - Mass Immunization (Roster Biller Only) | 6204749997 | This NPI is an additional NPI on the enrollment |
| O20140804001036 | NC | DME Supplier - Pharmacy | 6204749997 | Practice locations: Grantsboro, NC |
National Provider Directory
- Tax ID family
- Ability Network
Locations
11233B NC 55 Hwy
Grantsboro, NC 28529
Phone (252) 201-9012
11233 NC 55 Hwy
#B
Grantsboro, NC 28529
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | 11989 | NC | Yes |
Addresses
Primary practice location
11233B NC 55 Hwy E
Grantsboro, NC 28529-9471
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 277-2500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972920577 | Medicaid | NC | |
| 2145546 | Other | PK |
Other names
- Walmart Pharmacy 10-7238
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Other providers in Grantsboro, NC
- Realo Discount Drug Stores of Eastern North Carolina, Inc
- River Neuse Group, LLC
- Margaret Mary Rodzel
- David Schroeder
- Jason Heath Strickland
All providers in Grantsboro, NC · Community/Retail Pharmacy in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 9, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.