NPI |
1346268760 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
WAL-MART STORES EAST LP |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Other Organization Name |
WALMART PHARMACY 10-1026 |
Other name by which the organization provider is or has been known. |
Provider Other Organization Name Type Code |
3 |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider First Line Business Practice Location Address |
3200 JOHN WILLIAMS BLVD |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
BEDFORD |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
IN |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
474219153 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
8122750415 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
7/17/2006 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Last Update Date |
8/23/2023 |
The last name of the provider. If the provider is an individual, this is the legal name. |
Authorized Official Last Name |
LITTLE |
The first name of the provider, if the provider
is an individual. |
Authorized Official First Name |
SARAH |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Authorized Official Title or Position |
DIRECTOR OF HEALTHCARE CONTRACTING |
The city name in the location address of the provider being identified. |
Authorized Official Telephone Number |
4792772500 |
The State code in the location of the provider
being identified. |
Healthcare Provider Taxonomy Code 1 |
332B00000X |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Healthcare Provider Primary Taxonomy Switch 1 |
N |
The country code in the location address of the provider being identified. |
Healthcare Provider Taxonomy Code 2 |
333600000X |
The telephone number associated with the location address of the provider being identified. |
Healthcare Provider Primary Taxonomy Switch 2 |
N |
The date the provider was assigned a unique identifier (assigned an NPI). |
Healthcare Provider Taxonomy Code 3 |
3336C0003X |
The date that a record was last updated or changed. |
Provider License Number 3 |
60005034 |
The code designating the provider’s gender if the provider is a person. |
Provider License Number State Code 3 |
IN |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 3 |
Y |
|
Other Provider Identifier 1 |
100299390A |
|
Other Provider Identifier Type Code 1 |
05 |
|
Other Provider Identifier State 1 |
IN |
|
Other Provider Identifier 2 |
100299390 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Other Provider Identifier Type Code 2 |
05 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Other Provider Identifier State 2 |
IN |
|
Other Provider Identifier 3 |
2026429 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Other Provider Identifier Type Code 3 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Other Provider Identifier Issuer 3 |
PK |
|
Is Organization Subpart |
N |
|
NPI Certification Date |
8/23/2023 |
|