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WAL-MART STORES EAST LP NPI 1023295078


NPI Information

NPI: 1023295078
Provider Name: WAL-MART STORES EAST LP

Doing Business As: WAL-MART PHARMACY 10-3609

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

CLIA Number: 11D2174912

Address:
2940 ANVIL BLOCK RD
ELLENWOOD, GA
ZIP 30294
Phone: (404) 361-6961
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WAL-MART STORES EAST LP is a community/retail pharmacy pharmacy in Ellenwood, GA. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. WAL-MART STORES EAST LP NPI is 1023295078. The provider is registered as an organization entity type.
The provider Is Doing Business As Wal-mart Pharmacy 10-3609.

The provider's business location address is:

2940 ANVIL BLOCK RD
ELLENWOOD, GA
ZIP 30294-403
Phone: (404) 361-6961

The provider's authorized official is Sarah Little .
The authorized official title is Director Of Healthcare Contracting and has the following contact phone number (479) 277-2500.

The CLIA number assigned to this NPI record is 11D2174912 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/22/2008 and was last updated on 2/16/2017.


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:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1332B00000XDurable Medical Equipment & Medical SuppliesNo
2333600000XPharmacyNo
33336C0003XPharmacyCommunity/Retail PharmacyPHRE009458GEORGIAYes

Other Identifiers

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

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
12017395OTHERPK
2095731884AMEDICAIDGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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