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WALMART PHARMACY 10-5090
NPI 1609893775
Pharmacy - Community/Retail Pharmacy in De Pere, WI

Active since July 16, 2006CLIA 52D2261824 · Waiver
1415 LAWRENCE DR, DE PERE, WI 54115(920) 336-7168(920) 336-7586 Get Directions Write a Review

NPPES record last updated: April 15, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 15, 2024, Aug 30, 2023, Feb 15, 2017 (3 updates tracked since 2017).

About Walmart Pharmacy 10-5090 NPPES

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

WALMART PHARMACY 10-5090 (NPI 1609893775) is a healthcare organization registered as a community/retail pharmacy in De Pere, Wisconsin and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through June 5, 2028 and lists Sarah Little, Director Of Healthcare Contracting, as its authorized official.

NPPES Registry Identity

NPI1609893775
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameWAL-MART STORES EAST LP
Location Address1415 LAWRENCE DRDe Pere, WI 54115-3927
Mailing Address702 Sw 8th StBentonville, AR 72716-6209 · (479) 204-8550 · Fax (479) 277-4331
Phone(920) 336-7168
Fax(920) 336-7586
Organization SubpartNo
Authorized OfficialSarah LittleDirector Of Healthcare Contracting · (479) 277-2500
Enumeration DateJuly 16, 2006
Last NPPES UpdateApril 15, 20243 updates tracked since enumeration
NPPES CertifiedApril 15, 2024
✔ NPI 1609893775 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in WI · 8315-42
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
Also ListedPharmacy · Specialty PharmacyTaxonomy 3336S0011X
1415 LAWRENCE DR, De Pere, WI 54115
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Other Names 1

Doing Business AsWalmart Pharmacy 10-5090

Other Identifiers 2

Medicaid33270200WI
Other2110078Pk

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 52D2261824

Walmart Pharmacy 10-5127 · Barre Mills, WI
Active · expires Jun 5, 2028
CLIA Number52D2261824
Laboratory TypePharmacy
Certificate Effective DateJune 6, 2026
Certificate Expiration DateJune 5, 2028
Laboratory DirectorScott Horn
Laboratory Phone(920) 336-7168
Laboratory LocationWalmart Pharmacy 10-51274622 Mormon Coulee Rd, Barre Mills, WI 54601
CLIA data matches this NPI record on: 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.
159 services157 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.
158 services156 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.
11 services11 patients

Medical Equipment Supplier Medicare DMEPOS 13

Medicare supplier enrollment and the product categories Wal Mart Pharmacy 10-5090 carries, from the Medicare DMEPOS supplier directory.

Wal Mart Pharmacy 10-5090

DMEPOS supplier · De Pere, WIOperated by Wal-Mart Stores East, LP
⋮

Does not accept Medicare assignment

Wal Mart Pharmacy 10-5090 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)20499809
Medicare Participant SinceJuly 1, 2014
Supplier Location1415 Lawrence DrDe Pere, WI 54115
Phone(920) 336-7168
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 6

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

DANIEL JAMES HORN
Pharmacist
1415 LAWRENCE DR
DE PERE, WI 54115
Brown County (920) 336-7168
MR. RAMA KASETTY RPH
Pharmacist
1415 LAWRENCE DR
DE PERE, WI 54115
Brown County (920) 336-7168
TIMOTHY JOSEPH NIEDZWIECKI PHARMD
Pharmacist
1415 LAWRENCE DR
DE PERE, WI 54115
Brown County (920) 336-7168
WAL-MART STORES EAST, LP
Eyewear Supplier
1415 LAWRENCE DR
DE PERE, WI 54115
Brown County (920) 336-3416
NAOMI DEWITT
Pharmacist
1415 LAWRENCE DR
DE PERE, WI 54115
Brown County (920) 336-7168
DR. JERRY SULEWSKI PHARMD
Pharmacist
1415 LAWRENCE DR
DE PERE, WI 54115
Brown County (920) 336-7168

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 1609893775. It was assigned to this organization in the NPPES registry on July 16, 2006. The provider is doing business as Walmart Pharmacy 10-5090.

Where is Wal-Mart Stores East LP located?

Wal-Mart Stores East LP is located at 1415 Lawrence Dr, De Pere, WI 54115. The listed phone number is (920) 336-7168.

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 accept Medicare assignment for medical equipment?

No. As a Medicare medical equipment supplier, Wal Mart Pharmacy 10-5090 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 52D2261824) is associated with this NPI, valid through June 5, 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 52 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 April 15, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.