WAL-MART STORES EAST LP (NPI# 1023295078) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023295078 |
| Entity Type | Organization |
| Organization Name | WAL-MART STORES EAST LP |
| Other Organization Name | WAL-MART PHARMACY 10-3609 |
| Practice Address |
2940 Anvil Block Rd Ellenwood GA 30294-2403 |
| Mailing Address |
702 Sw 8th St Bentonville AR 72716-0445 |
| Practice Telephone | 4043616961 |
| Mailing Telephone | 4792048550 |
| Mailing Fax Number | 4792774331 |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2017-02-16 |
| Authorized Official Name | SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING) |
| Authorized Official Telephone | 4792772500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
PHRE009458 | GA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2017395 | 01 | |
| GA | 095731884A | 05 |
| Other Name | Type Code |
|---|---|
| WAL-MART PHARMACY 10-3609 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437657426 | Wal-mart Stores East Lp | Pharmacy | 14325 Sw 268th Ter, Homestead, FL 33032-7555 | 2018-01-25 |
| 1003323387 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 73 Fellowship, Mt Laurel, NJ 08054 | 2018-01-08 |
| 1033623236 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 820 Balmy Beach Dr, Apopka, FL 32703-0000 | 2017-11-27 |
| 1477065704 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 337 Pinewood Rd, Sumter, SC 29150-5442 | 2017-10-26 |
| 1841709516 | Wal-mart Stores East Lp | Pharmacy | 1109 W Corbett Ave, Swansboro, NC 28584-8461 | 2017-09-26 |
| 1396264305 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | Nec Landstar and Arbor Meadows Blvd, Orlando, FL 32801-0000 | 2017-09-12 |
| 1720506967 | Wal-mart Stores East Lp | Pharmacy | 955 S Woodland Blvd, Deland, FL 32720-0000 | 2017-09-08 |
| 1164944104 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 7360 Navarre Pkwy, Navarre, FL 32566-7752 | 2017-07-12 |
| 1568984912 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 3655 Browns Bridge Rd, Cumming, GA 30028 | 2017-07-07 |
| 1518498534 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 5001 Nine Mile Rd, Richmond, VA 23223-5732 | 2017-03-22 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Retail Food Store | WAL-MART STORES EAST LP | 1400 COUNTY RD 64 HORSEHEADS NY 14845 |
| Street Address |
2940 ANVIL BLOCK RD |
| City | ELLENWOOD |
| State | GA |
| Zip Code | 30294-2403 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770124323 | Lula Varist Gholson | Counselor | Christian Counselor Ma Lou Gholson, 549 Lamar Drive, Forest Park, GA 30294 | 2019-10-04 |
| 1609428176 | Tykechia Todd | Ambulance | 3644 Caseys Cove, Ellenwood, GA 30294 | 2019-07-15 |
| 1891285243 | Ayana Aqila Thornton | Nurse Practitioner | 5654 Hosea Court, Ellenwood, GA 30294 | 2018-05-11 |
| 1346748837 | Kakethia S. Mack | Nurse Practitioner | 4124 Bosenberry Way, Ellenwood, GA 30294 | 2018-01-30 |
| 1851819312 | Tatiana Marcus | Prosthetist | 3895 Busby Mill Ct., Ellenwood, GA 30294 | 2017-09-05 |
| 1962944991 | Fairview Urgent Care, LLC | Clinic/Center | 4475 West Village Pkwy, Ellenwood, GA 30294 | 2016-11-08 |
| 1982006169 | Kristal Cure | Licensed Practical Nurse | 4057 Madiosn Court, Ellenwood, GA 30294 | 2014-09-19 |
| 1801233515 | 1st Class Learning and Performing Arts | Local Education Agency (LEA) | 5474 Platte Dr, Ellenwood, GA 30294 | 2013-06-04 |
| 1235480138 | Life Wellness Group of Atlanta | Home Delivered Meals | 145 Wilhemina Drive, Ellenwood, GA 30294 | 2012-10-02 |
| 1346548450 | William K Holley IIi | Counselor | 2732 Holly Berry Dr, Ellenwood, GA 30294 | 2011-03-14 |
| Find all providers in zip 30294 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| 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. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619070463 | Georgia Cvs Pharmacy LLC | Pharmacy | 80 Fairview Rd, Ellenwood, GA 30294-2767 | 2006-09-07 |
| 1063427185 | Walgreen Co | Pharmacy | 315 Fairview Rd, Ellenwood, GA 30294-2634 | 2006-07-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154922441 | Southern Pharmacy Group LLC | Pharmacy | 110 Allison St., Jesup, GA 31545 | 2020-11-04 |
| 1184225526 | Svdp Georgia Community Pharmacy LLC | Pharmacy | 2050 Chamblee Tucker Rd Ste C, Chamblee, GA 30341-3343 | 2020-11-03 |
| 1194325860 | Panola Pharmacy LLC | Pharmacy | 2348 Panola Rd Unit C, Lithonia, GA 30058-5406 | 2020-10-30 |
| 1659971539 | Bob and Jeff's Hometown Pharmacy of Thomasville, LLC | Pharmacy | 309 Smith Ave, Thomasville, GA 31792-5534 | 2020-10-29 |
| 1679171979 | Dfg LLC | Pharmacy | 638 Historic Hwy 441 Suite A, Demorest, GA 30530 | 2020-10-09 |
| 1033716915 | Au Medical Center, Inc. | Pharmacy | 818 Saint Sebastian Way Ste 402, Augusta, GA 30901-2654 | 2020-10-05 |
| 1043817208 | Mlk Pharmacy2.0 | Pharmacy | 2457 Mlk Jr Dr Sw Ste A, Atlanta, GA 30311-1712 | 2020-10-01 |
| 1508470964 | Swain Drug Company LLC | Pharmacy | 855 Bowens Mill Rd Sw Suite E, Douglas, GA 31533 | 2020-09-03 |
| 1205446341 | Sunny Pharmacy | Pharmacy | 5364 Jonesboro Rd, Lake City, GA 30260-3557 | 2020-08-04 |
| 1841818044 | Hospital Authority of Miller County | Pharmacy | 213 Delores Street, Colquitt, GA 39837 | 2020-07-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.