WAL-MART STORES EAST LP
NPI 1104843424
Pharmacy - Community/Retail Pharmacy in Lilburn, GA
About Wal-mart Stores East Lp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
WAL-MART STORES EAST LP (NPI 1104843424), doing business as Wal-mart Pharmacy 10-1373, is a healthcare organization registered as a community/retail pharmacy in Lilburn, Georgia and active in the NPI registry since July 2006. The organization lists Kimberly Canonic, Senior Director, Enrollment, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 3
Other Names 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Wal-mart Stores East Lp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Wal-Mart Stores East LP, which bills Medicare for the services they deliver. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 2
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.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Wal-Mart Stores East LP's NPI number?
The NPI number for Wal-Mart Stores East LP is 1104843424. It was assigned to this organization in the NPPES registry on July 16, 2006. The provider is doing business as Wal-Mart Pharmacy 10-1373.
Where is Wal-Mart Stores East LP located?
Wal-Mart Stores East LP is located at 4004 Lawrenceville Hwy NW, Lilburn, GA 30047. The listed phone number is (770) 921-0228.
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.
Is Wal-Mart Stores East LP enrolled in Medicare?
Yes. Wal-Mart Stores East LP is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Wal-Mart Stores East LP?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Wal-Mart Stores East LP. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Wal-Mart Stores East LP accept?
Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arkansas Health & Wellness and 47 other insurers list Wal-Mart Stores East LP as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Wal-Mart Stores East LP was last updated on July 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Wal-Mart Stores East Lp · NPI 1104843424
Community/Retail Pharmacy organization in Lilburn, Georgia. Organization record, active in the CMS NPPES registry since July 16, 2006.
## Identity
- **NPI:** 1104843424 (Entity type: Organization)
- **Enumerated:** July 16, 2006
- **Primary specialty:** Pharmacy - Community/Retail Pharmacy · taxonomy 3336C0003X
- **Also known as:** WAL-MART PHARMACY 10-1373 (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Kimberly Canonic, SENIOR DIRECTOR, ENROLLMENT
## Practice location
- **Address:** 4004 LAWRENCEVILLE HWY NW, Lilburn, GA 30047-2820
- **Phone:** (770) 921-0228
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 11, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1104843424) · Data from the CMS NPPES public registry.