WAL-MART STORES EAST LP NPI 1013934397

NPI Details

WAL-MART STORES EAST LP is a pharmacy in Ellicott City, MD. The provider is a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. WAL-MART STORES EAST LP NPI is 1013934397. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

3200 N RIDGE RD
ELLICOTT CITY, MD
ZIP 21043-363
Phone: (410) 418-9703
Fax: (410) 480-1732

The provider's authorized official is Kimberly Canonic .
The authorized official title is Senior Director, Enrollment and has the following contact phone number (480) 277-6348.

The CLIA number assigned to this NPI record is 21D2158578 - pharmacy with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

• Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count (HCPCS:K1034)
• Administration of influenza virus vaccine (HCPCS:G0008)
• Influenza vaccine split virus, preservative free (HCPCS:90662)
• Fee covid-19 vac 13 res (HCPCS:0124A)
• Adm sarscv2 30mcg trs-sucr 1 (HCPCS:0051A)
• Adm sarscov2 50mcg/0.25mlbst (HCPCS:0064A)
• Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use (HCPCS:90677)
• Adm sarscv2 30mcg trs-sucr b (HCPCS:0054A)
• Administration of pneumococcal vaccine (HCPCS:G0009)

The enumeration date for this NPI number is 7/16/2006 and was last updated on 5/30/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.