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WAL-MART STORES EAST LP NPI 1467470963


NPI Information

NPI: 1467470963
Provider Name: WAL-MART STORES EAST LP

Doing Business As: WALMART PHARMACY 10-0152

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

CLIA Number: 26D2144269

Address:
12862 STATE ROUTE 21
DE SOTO, MO
ZIP 63020
Phone: (636) 586-9666
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WAL-MART STORES EAST LP is a community/retail pharmacy pharmacy in De Soto, MO. 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 1467470963. The provider is registered as an organization entity type.
The provider Is Doing Business As Walmart Pharmacy 10-0152.

The provider's business location address is:

12862 STATE ROUTE 21
DE SOTO, MO
ZIP 63020-742
Phone: (636) 586-9666

The provider's authorized official is Matthew Mcmullin .
The authorized official title is Director, Contracting and has the following contact phone number (479) 371-8711.

The CLIA number assigned to this NPI record is 26D2144269 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/17/2006 and was last updated on 12/1/2023.


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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1333600000XPharmacyNo
2332B00000XDurable Medical Equipment & Medical SuppliesNo
33336C0003XPharmacyCommunity/Retail Pharmacy2002009218MISSOURIYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12047591OTHERPK
2608878708MEDICAIDMISSOURI

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: 5/5/2024

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