WAL-MART STORES EAST LP (NPI# 1619994787) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619994787 |
| Entity Type | Organization |
| Organization Name | WAL-MART STORES EAST LP |
| Other Organization Name | WAL-MART PHARMACY 10-3268 |
| Practice Address |
200 E State Highway 64 Antigo WI 54409-2967 |
| Mailing Address |
702 Sw 8th St Bentonville AR 72716-0445 |
| Practice Telephone | 7156271636 |
| Practice Fax Number | 7156277987 |
| Mailing Telephone | 4792048550 |
| Mailing Fax Number | 4792774331 |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2017-02-15 |
| 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 |
8133-42 | WI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2109894 | 01 | |
| WI | 33255600 | 05 |
| Other Name | Type Code |
|---|---|
| WAL-MART PHARMACY 10-3268 | 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 |
200 E STATE HIGHWAY 64 |
| City | ANTIGO |
| State | WI |
| Zip Code | 54409-2967 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083213318 | Paul Kirk Zwieg | Pharmacist | 200 E State Highway 64, Antigo, WI 54409-2967 | 2020-10-19 |
| 1144828559 | Kristen M Mattmiller | Pharmacist | 200 E State Highway 64, Antigo, WI 54409-2967 | 2020-10-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407454036 | Jason Peter Cueny | Pharmacist | 200 E Highway 64, Antigo, WI 54409 | 2020-10-15 |
| 1770194524 | Christpher George Rowe | Technician | 825 Clermont S Apt 7, Antigo, WI 54409 | 2020-08-14 |
| 1033753512 | Joseph Gerger | Technician | 711 Badger Ave, Antigo, WI 54409 | 2019-10-29 |
| 1225368780 | Integrated Pain Solutions LLC | Clinic/Center | 2327 Neva Road, Antigo, WI 54409 | 2010-01-06 |
| 1558525212 | Jessica E Rosenberg | Social Worker | 310 South Superior Street, Antigo, WI 54409 | 2008-07-11 |
| 1053433292 | Raymond J Portman | Dentist | 705 Fifth Ave, Antigo, WI 54409 | 2007-04-06 |
| 1699801316 | Rick L Perkins | Obstetrics & Gynecology | Aspirus General Clinic, 110 East 5th Avenue, Antigo, WI 54409 | 2007-02-26 |
| 1205999646 | Earl J Roth | Chiropractor | 612 Century Ave, Antigo, WI 54409 | 2006-12-18 |
| 1811061187 | Rosanne Schermetzler | Occupational Therapist | 720 Ackley Street, Antigo, WI 54409 | 2006-11-20 |
| 1912084070 | Antigo Total Therapy & Sports Rehab Center Inc | Physical Therapist | 720 Askley Street, Antigo, WI 54409 | 2006-11-01 |
| Find all providers in zip 54409 | ||||
| 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 |
|---|---|---|---|---|
| 1346285707 | Vosmek Drug Store Inc | Pharmacy | 536 5th Ave, Antigo, WI 54409-2221 | 2006-06-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942816939 | The Duluth Clinic, Ltd. | Pharmacy | 204 Belknap St, Ste 100, Superior, WI 54880-2964 | 2020-09-16 |
| 1902417207 | Ipack Pharmacy LLC | Pharmacy | 17000 W North Ave Ste 108w, Brookfield, WI 53005-4423 | 2020-08-11 |
| 1851939037 | Ascension Wisconsin Pharmacy, Inc | Pharmacy | 10180 Washington Ave Ste 102, Mount Pleasant, WI 53177-1604 | 2019-12-18 |
| 1558906354 | Life Change Rx 4 LLC | Pharmacy | 6300 N 76th St Ste 246, Milwaukee, WI 53218-1208 | 2019-11-15 |
| 1285278978 | Life Change Rx 3 LLC | Pharmacy | 7115 W Capitol Dr, Milwaukee, WI 53216-2051 | 2019-11-05 |
| 1295377703 | Hayat Pharmacy 21 LLC. | Pharmacy | 2333 Northwestern Ave Ste 120, Racine, WI 53404-2520 | 2019-10-16 |
| 1487296737 | Xperience Pharmacy LLC | Pharmacy | 5715 W Appleton Ave, Milwaukee, WI 53210-2250 | 2019-10-08 |
| 1962053421 | Hayat Pharmacy 19 LLC | Pharmacy | 805 W. Layton Ave. Suite A, Milwaukee, WI 53221 | 2019-09-26 |
| 1275182925 | Walgreen Co | Pharmacy | 2265 N Mayfair Rd, Wauwatosa, WI 53226-2207 | 2019-09-05 |
| 1982257200 | Hayat Pharmacy 16 LLC | Pharmacy | 603 N 36th St, Milwaukee, WI 53208-3826 | 2019-07-17 |
| 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.