WALMART PHARMACY 10-1012
NPI 1063439131
Pharmacy - Community/Retail Pharmacy in Beaver Dam, WI

Q: What is Wal-Mart Stores East LP's NPI number?

The NPI number for Wal-Mart Stores East LP is 1063439131. It was assigned to this organization in the NPPES registry on July 16, 2006. The provider is doing business as Walmart Pharmacy 10-1012.

Q: What is Wal-Mart Stores East LP's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Active since July 16, 2006CLIA 52D2258448 · Waiver

120 FRANCES LN, BEAVER DAM, WI 53916(920) 885-5808(920) 885-5908 Get Directions Write a Review

NPPES record last updated: August 23, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Aug 23, 2023, Feb 15, 2017 (2 updates tracked since 2017).

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About Walmart Pharmacy 10-1012 NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WALMART PHARMACY 10-1012 (NPI 1063439131) is a healthcare organization registered as a community/retail pharmacy in Beaver Dam, Wisconsin and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through April 20, 2028 and lists Sarah Little, Director Of Healthcare Contracting, as its authorized official.

NPPES Registry Identity

NPI1063439131

Entity TypeOrganization

Primary Taxonomy3336C0003X

Legal Business NameWAL-MART STORES EAST LP

Location Address120 FRANCES LNBeaver Dam, WI 53916-1165

Mailing Address702 Sw 8th StBentonville, AR 72716-0445 · (479) 204-8550 · Fax (479) 277-4331

Phone(920) 885-5808

Fax(920) 885-5908

Organization SubpartNo

Authorized OfficialSarah LittleDirector Of Healthcare Contracting · (479) 277-2500

Enumeration DateJuly 16, 2006

Last NPPES UpdateAugust 23, 20232 updates tracked since enumeration

NPPES CertifiedAugust 23, 2023

✔ NPI 1063439131 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers

Taxonomy Code3336C0003X

License✔ Licensed in WI · 8417-42

Definition

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.

Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X

Also ListedPharmacyTaxonomy 333600000X

120 FRANCES LN, Beaver Dam, WI 53916

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Other Names 1

Doing Business AsWalmart Pharmacy 10-1012

Other Identifiers 2

Other2110165Pk

Medicaid33276900WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 52D2258448

Walmart Pharmacy 10-1012 · Beaver Dam, WI

Active · expires Apr 20, 2028

CLIA Number52D2258448

Laboratory TypePharmacy

Certificate Effective DateApril 21, 2026

Certificate Expiration DateApril 20, 2028

Laboratory DirectorWilliam Perego

Laboratory Phone(920) 885-5808

Laboratory LocationWalmart Pharmacy 10-1012120 Frances Ln, Beaver Dam, WI 53916

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Administration of influenza virus vaccine G0008

The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.

364 services359 patients

Influenza vaccine split virus, preservative free 90662

The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.

343 services340 patients

Administration of pneumococcal vaccine G0009

The pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.

20 services20 patients

Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use 90677

The Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.

12 services12 patients

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ASIEDU BOATENG

Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)