Wal-Mart Stores East LP
Pharmacy, Community/Retail Pharmacy in Black River Falls, WI. Organization (NPI-2).
NPI number1417975111
StatusActive
Last updated in NPPESAug 29, 2023
Details
- NPI
- 1417975111
- Entity type
- Organization (NPI-2)
- Legal business name
- Wal-Mart Stores East LP
- Organization subpart
- No
- Enumeration date
- Jul 18, 2006
- Certification date
- Aug 29, 2023
- Last updated
- Aug 29, 2023
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · DME SUPPLIER - PHARMACY
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | 8703-42 | WI | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – | |
| 333600000X | Pharmacy | – | – |
Other names
- Wal-Mart Pharmacy 10-1277 (Doing Business As)
Practice location
611 State Highway 54Black River Falls, WI 54615-5453
Phone 715-284-9115
Mailing address
702 Sw 8th StBentonville, AR 72716-0445
Authorized official
Sarah Little
Director Of Healthcare Contracting
4792772500
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Other Community/Retail Pharmacy providers in Black River Falls, WI
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