WAL-MART STORES EAST LP (NPI# 1760409940) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760409940 |
| Entity Type | Organization |
| Organization Name | WAL-MART STORES EAST LP |
| Other Organization Name | WAL-MART PHARMACY 10-0724 |
| Practice Address |
630 E Broadway Blvd Jefferson City TN 37760-4900 |
| Mailing Address |
702 Sw 8th St Bentonville AR 72716-0445 |
| Practice Telephone | 8654753736 |
| Practice Fax Number | 8654753954 |
| Mailing Telephone | 4792048550 |
| Mailing Fax Number | 4792774331 |
| Enumeration Date | 2006-07-16 |
| 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 |
C2243 | TN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 1454056 | 05 | |
| PK | 2091090 | 01 |
| Other Name | Type Code |
|---|---|
| WAL-MART PHARMACY 10-0724 | 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 |
|---|---|---|
| Virginia Business Entities | Wal-Mart Stores East LP | 702 Sw 8th St, Bentonville, Arkansas 72716-0555 |
| Street Address |
630 E BROADWAY BLVD |
| City | JEFFERSON CITY |
| State | TN |
| Zip Code | 37760-4900 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972582070 | Cherie Renee Archambeault | Optometrist | 630 E Broadway Blvd, Jefferson City, TN 37760-4900 | 2006-01-17 |
| 1417456245 | Robert Bruce Lowry | Pharmacist | 630 E Broadway Blvd, Jefferson City, TN 37760-4900 | 2018-02-07 |
| 1255830303 | Darius Fitzgerald Marra | Pharmacist | 630 E Broadway Blvd, Jefferson City, TN 37760-4900 | 2018-02-05 |
| 1578061297 | Megan Elizabeth Alder | Pharmacist | 630 E Broadway Blvd, Jefferson City, TN 37760-4900 | 2018-01-28 |
| 1922198126 | Wal-mart Stores East, Lp | Technician/Technologist | 630 E Broadway Blvd, Jefferson City, TN 37760-4900 | 2006-10-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699235929 | Emmley L Cole | Nurse Practitioner | 277 E W Broadway Blvd, Jefferson, TN 37760 | 2019-03-22 |
| 1275044877 | Cindy Anderson | Nurse Practitioner | 277 E Broadway Blvd, Jefferson City, TN 37760 | 2017-10-23 |
| 1801259940 | Mcfarland Group, Inc. | Durable Medical Equipment & Medical Supplies | 665 E Broadway Blvd, Jefferson City, TN 37760 | 2016-04-04 |
| 1124422266 | Penny Williams-cordeiro | Nurse Practitioner | 1901 Brookside Drive, Suite 105, Kingsport, TN 37760 | 2014-10-17 |
| 1215363841 | Lindsey Ann Clyde | Physician Assistant | 120 Hospital Dr Ste 130, Jefferson City, TN 37760 | 2013-09-14 |
| 1679849814 | Allison Renee Farris | Surgery | 120 Hospital Dr Ste G20, Jefferson City, TN 37760 | 2012-03-31 |
| 1245562891 | Steven Jarvis Monroe | Dentist | 156 W. Broadway Blvd., Jefferson City, TN 37760 | 2010-02-08 |
| 1952560625 | Summit Medical Group,pllc | Internal Medicine | 380 W Broadway Blvd, Jefferson City, TN 37760 | 2008-06-06 |
| 1780756189 | Steven J Monroe Dds PC | Dentist | 156 W Broadway Blvd, Jefferson City, TN 37760 | 2006-11-14 |
| 1720188600 | Dennis U Spjut | Psychologist | 732 E Jefferson St, Dennis Spjut Phd, Jefferson City, TN 37760 | 2006-09-22 |
| Find all providers in zip 37760 | ||||
| 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 |
|---|---|---|---|---|
| 1104905884 | Murphys Sav-mor Pharmacy Inc | Pharmacy | 1403 Russell Ave, Jefferson City, TN 37760-2530 | 2006-11-03 |
| 1023113248 | Jefferson City Apothecary LLC | Pharmacy | 1739 Elm Ct Ste 108, Jefferson City, MO 65101-4303 | 2006-09-13 |
| 1578666277 | Tennessee Cvs Pharmacy LLC | Pharmacy | 139 E Broadway Blvd, Jefferson City, TN 37760-2536 | 2006-09-07 |
| 1326055344 | Walgreen Co | Pharmacy | 3740 W Truman Blvd, Jefferson City, MO 65109-0537 | 2006-08-02 |
| 1750396784 | Walgreen Co | Pharmacy | 132 E Broadway Blvd, Jefferson City, TN 37760-2535 | 2006-07-29 |
| 1194767384 | Missouri Cvs Pharmacy LLC | Pharmacy | 735 W Stadium Blvd, Jefferson City, MO 65109-4753 | 2006-06-12 |
| 1952755472 | K-mart | Pharmacy | 2304 Missouri Blvd, Jefferson City, MO 65109-4729 | 2016-04-21 |
| 1073979522 | Jeff City Pharmacist Group LLC Dba Md Pharmacy Store 2 | Pharmacy | 657 E Broadway Blvd, Jefferson City, TN 37760 | 2016-01-13 |
| 1922417021 | Walgreens | Pharmacy | 900 Eastland Dr, Jefferson City, MO 65101-3894 | 2014-08-04 |
| 1194084772 | Capital Care Pharmacy | Pharmacy | 1125 Madison St, Jefferson City, MO 65101-5227 | 2012-05-16 |
| Find all providers in JEFFERSON CITY | ||||
| City | JEFFERSON CITY |
| Zip Code | 37760 |
Please comment or provide details below to improve the information on WAL-MART STORES EAST LP.
| 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.