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WAL-MART STORES EAST LP
NPI 1174540405
Pharmacy - Community/Retail Pharmacy in La Grange, KY

Active since July 16, 2006CLIA 18D2144980 · Waiver
1015 NEW MOODY LN, LA GRANGE, KY 40031(502) 222-9797 Get Directions Write a Review

NPPES record last updated: June 5, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 5, 2025, Feb 16, 2017 (2 updates tracked since 2017).

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 1174540405), doing business as Walmart Pharmacy 10-1053, is a healthcare organization registered as a community/retail pharmacy in La Grange, Kentucky and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through February 26, 2028 and lists Kimberly Canonic, Senior Director, Enrollment, as its authorized official.

NPPES Registry Identity

NPI1174540405
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameWAL-MART STORES EAST LP
Location Address1015 NEW MOODY LNLa Grange, KY 40031-9142
Mailing Address702 Sw 8th StBentonville, AR 72716-0445
Phone(502) 222-9797
Organization SubpartNo
Authorized OfficialKimberly CanonicSenior Director, Enrollment · (480) 277-6348
Enumeration DateJuly 16, 2006
Last NPPES UpdateJune 5, 20252 updates tracked since enumeration
NPPES CertifiedJune 5, 2025
✔ NPI 1174540405 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 KY · P06069
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
1015 NEW MOODY LN, La Grange, KY 40031
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Other Names 1

Doing Business AsWalmart Pharmacy 10-1053

Other Identifiers 3

Medicaid5402977200KY
Other2031895Pk
Medicaid5400660600KY

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 18D2144980

Wal-Mart Stores East, LP Dba Wal-Mart Pharmacy #10-1053 · La Grange, KY
Active · expires Feb 26, 2028
CLIA Number18D2144980
Laboratory TypePharmacy
Certificate Effective DateFebruary 27, 2026
Certificate Expiration DateFebruary 26, 2028
Laboratory DirectorDennis Cromer
Laboratory Phone(502) 222-9797
Laboratory LocationWal-Mart Stores East, LP Dba Wal-Mart Pharmacy #10-10531015 New Moody Lane, La Grange, KY 40031
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 3

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.
206 services204 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.
196 services194 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.
16 services16 patients

Other Providers at the Same Location NPPES 12

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

ELIZABETH PAIGE WHITAKER PHARMD
Pharmacist
1015 NEW MOODY LN
LA GRANGE, KY 40031
Oldham County (502) 222-9797
CAROLYN HOLLKAMP APRN
Nurse Practitioner (Family)
1015 NEW MOODY LN
LA GRANGE, KY 40031
Oldham County (502) 991-0589
PAMELA WILSON
Technician/Technologist (Optician)
1015 NEW MOODY LN
LA GRANGE, KY 40031
Oldham County (502) 222-5292
DR. NGOC C DO-BIZZELL OD
Optometrist
1015 NEW MOODY LN
LAGRANGE, KY 40031
Oldham County (502) 222-2889
MRS. SUSAN STEITZ APRN
Nurse Practitioner (Family)
1015 NEW MOODY LN
LA GRANGE, KY 40031
Oldham County (502) 991-0589
DONNA JANE OWENS
Technician/Technologist (Optician)
1015 NEW MOODY LN
LA GRANGE, KY 40031
Oldham County (502) 222-2592
CHRISTY STURGILL ARNP
Nurse Practitioner
1015 NEW MOODY LN
LA GRANGE, KY 40031
Oldham County (502) 991-0589
JOSEPH BRADLEY MULLIGAN LDO
Technician/Technologist (Optician)
1015 NEW MOODY LN
LA GRANGE, KY 40031
Oldham County (502) 222-5292

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 1174540405. It was assigned to this organization in the NPPES registry on July 16, 2006. The provider is doing business as Walmart Pharmacy 10-1053.

Where is Wal-Mart Stores East LP located?

Wal-Mart Stores East LP is located at 1015 New Moody Ln, La Grange, KY 40031. The listed phone number is (502) 222-9797.

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.

Does Wal-Mart Stores East LP hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 18D2144980) is associated with this NPI, valid through February 26, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

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 Arizona Complete Health and 50 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 June 5, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.