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WAL-MART STORES EAST LP
NPI 1205380474
Pharmacy in Salem, IN

Active since August 05, 2016CLIA 15D2124298 · Waiver
1309 E HACKBERRY ST, SALEM, IN 47167(812) 883-8722(812) 883-7814 Get Directions Write a Review

NPPES record last updated: June 9, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 9, 2025, Feb 15, 2017, Jan 18, 2017 and 1 more (4 updates tracked since 2016).

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 1205380474), doing business as Walmart Pharmacy 10-7087, is a healthcare organization registered as a pharmacy in Salem, Indiana and active in the NPI registry since August 2016. The organization holds a CLIA Waiver certificate valid through January 11, 2027 and lists Kimberly Canonic, Senior Director, Enrollment, as its authorized official.

NPPES Registry Identity

NPI1205380474
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameWAL-MART STORES EAST LP
Location Address1309 E HACKBERRY STSalem, IN 47167-9604
Mailing Address702 Sw 8th St, Mailstop 0445Bentonville, AR 72716-6209 · (479) 204-8550 · Fax (479) 204-8550
Phone(812) 883-8722
Fax(812) 883-7814
Organization SubpartNo
Authorized OfficialKimberly CanonicSenior Director, Enrollment · (480) 277-6348
Enumeration DateAugust 5, 2016
Last NPPES UpdateJune 9, 20254 updates tracked since enumeration
NPPES CertifiedJune 9, 2025
✔ NPI 1205380474 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
License✔ Licensed in IN · 6006578A
Definition
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.
Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X
Also ListedPharmacy · Community/Retail PharmacyTaxonomy 3336C0003X
1309 E HACKBERRY ST, Salem, IN 47167
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Other Names 1

Doing Business AsWalmart Pharmacy 10-7087

Other Identifiers 1

Other2164027Pk

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 15D2124298

Wal-Mart Stores East, LP Dba Wal-Mart Pharmacy #10-7087 · Salem, IN
Active · expires Jan 11, 2027
CLIA Number15D2124298
Laboratory TypePharmacy
Certificate Effective DateJanuary 12, 2025
Certificate Expiration DateJanuary 11, 2027
Laboratory DirectorRobert Earl Davis II
Laboratory Phone(479) 258-6734
Laboratory LocationWal-Mart Stores East, LP Dba Wal-Mart Pharmacy #10-70871309 E Hackberry St, Salem, IN 47167
CLIA data matches this NPI record on: Address Name
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.
232 services229 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.
222 services219 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.
27 services27 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.
19 services19 patients

Medical Equipment Supplier Medicare DMEPOS 12

Medicare supplier enrollment and the product categories Walmart Pharmacy 10-7087 carries, from the Medicare DMEPOS supplier directory.

Walmart Pharmacy 10-7087

DMEPOS supplier · Salem, INOperated by Wal-Mart Stores East, LP
⋮

Does not accept Medicare assignment

Walmart Pharmacy 10-7087 has not agreed to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients may be charged more than the Medicare-approved amount; confirm the expected cost with the supplier before ordering.

PTAN (Medicare Supplier Number)20498087
Medicare Participant SinceJuly 1, 2014
Supplier Location1309 E Hackberry StSalem, IN 47167
Phone(812) 883-8722
Supplier Specialties
Pharmacy Optician

Medicare Product Categories

Epoetin
Epoetin is a man-made version of human erythropoietin (EPO)
Immunosuppressive Drugs
Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
Infusion Drugs
Nebulizer Drugs
Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
Oral Anticancer Drugs
FDA anticancer drugs
Oral Antiemetic Drugs
FDA antiemetic drugs
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Other Providers at the Same Location NPPES 3

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

MARCUS DUCHEMIN PHARMD
Pharmacist
1309 E HACKBERRY ST
SALEM, IN 47167
Washington County (812) 883-8722
MR. JEFF DAY RPH
Pharmacist
1309 E HACKBERRY ST
SALEM, IN 47167
Washington County (812) 883-8722
WAL-MART STORES EAST, LP
Eyewear Supplier
1309 E HACKBERRY ST
SALEM, IN 47167
Washington County (812) 883-8812

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 1205380474. It was assigned to this organization in the NPPES registry on August 5, 2016. The provider is doing business as Walmart Pharmacy 10-7087.

Where is Wal-Mart Stores East LP located?

Wal-Mart Stores East LP is located at 1309 E Hackberry St, Salem, IN 47167. The listed phone number is (812) 883-8722.

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

The primary specialty registered for this NPI is Pharmacy with taxonomy code 333600000X.

Does Wal-Mart Stores East LP accept Medicare assignment for medical equipment?

No. As a Medicare medical equipment supplier, Walmart Pharmacy 10-7087 does not accept Medicare assignment for equipment and supplies, so patients may be charged more than the Medicare-approved amount. Confirm the expected cost with the supplier before ordering.

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

Yes. A Certificate of Waiver (number 15D2124298) is associated with this NPI, valid through January 11, 2027. 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 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.