Wal-Mart Stores East LP
Pharmacy, Community/Retail Pharmacy in Indianapolis, IN. Organization (NPI-2).
Details
- NPI
- 1801209796
- Entity type
- Organization (NPI-2)
- Legal business name
- Wal-Mart Stores East LP
- Organization subpart
- No
- Enumeration date
- Jun 9, 2014
- Certification date
- Jun 9, 2025
- Last updated
- Jun 9, 2025
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 | 60006393A | IN | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – |
Other names
- Walmart Pharmacy 10-4053 (Doing Business As)
Practice location
5555 Michigan RdIndianapolis, IN 46228-2219
Phone 317-287-0427 · Fax 317-287-0428
Mailing address
702 Sw 8th StBentonville, AR 72716-0445
Phone 479-277-1242 · Fax 479-277-4331
Authorized official
Kimberly Canonic
Senior Director, Enrollment
4802776348
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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