WAL-MART STORES EAST LP
NPI 1861542110
Pharmacy - Community/Retail Pharmacy in Versailles, MO

Active since January 11, 2007
1003 W NEWTON ST, VERSAILLES, MO 65084(573) 378-5421 Get Directions Write a Review

NPPES record last updated: May 30, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: May 30, 2025, Feb 20, 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 1861542110), doing business as Walmart Pharmacy 10-0357, is a healthcare organization registered as a community/retail pharmacy in Versailles, Missouri and active in the NPI registry since January 2007. The organization lists Kimberly Canonic, Senior Director, Enrollment, as its authorized official.

NPPES Registry Identity

NPI1861542110
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameWAL-MART STORES EAST LP
Location Address1003 W NEWTON STVersailles, MO 65084-1813
Mailing Address702 Sw 8th StBentonville, AR 72716-0445
Organization SubpartNo
Authorized OfficialKimberly CanonicSenior Director, Enrollment · (480) 277-6348
Enumeration DateJanuary 11, 2007
Last NPPES UpdateMay 30, 20252 updates tracked since enumeration
NPPES CertifiedMay 30, 2025
NPI 1861542110 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 MO · 2002009217
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
1003 W NEWTON ST, Versailles, MO 65084

Other Names 1

Doing Business AsWalmart Pharmacy 10-0357

Other Identifiers 2

Medicaid602242000MO
Other2050753Pk

Accepted Insurance

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the 2024 & 2026 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.
193 services191 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.
187 services185 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.
38 services38 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.
14 services14 patients

Medical Equipment Supplier Medicare DMEPOS 11

Medicare supplier enrollment and the product categories Wal-Mart Pharmacy 10-0357 carries, from the Medicare DMEPOS supplier directory.

Wal-Mart Pharmacy 10-0357

DMEPOS supplier · Versailles, MOOperated by Wal-Mart Stores East, LP

Does not accept Medicare assignment

Wal-Mart Pharmacy 10-0357 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)20490749
Medicare Participant SinceJuly 1, 2014
Supplier Location1003 W Newton StVersailles, MO 65084
Supplier Specialties
Pharmacy

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 4

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

Pharmacist
1003 W NEWTON ST
VERSAILLES, MO 65084
Pharmacist
1003 W NEWTON ST
VERSAILLES, MO 65084
Pharmacist
1003 W NEWTON ST
VERSAILLES, MO 65084
Pharmacist
1003 W NEWTON ST
VERSAILLES, MO 65084

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1861542110, enumerated as an "organization" on January 11, 2007.

The provider is located at 1003 W NEWTON ST VERSAILLES, MO 65084 and the phone number is (573) 378-5421.

Pharmacy with taxonomy code 3336C0003X and a focus in Community/Retail Pharmacy.

The provider might be accepting Accepts: Alliant Health Plans, Inc., Ambetter from Absolute. Please consult your insurance carrier or call the provider to verify.