Wal-Mart Stores East LP
NPI 1053782615ActiveOrganization· Pharmacy· Simpsonville, SC
Pharmacy in Simpsonville, South Carolina, registered in NPPES in October 2015. The authorized official on file is Kimberly Canonic, Senior Director, Enrollment. Medicare paid $33,139 for services to 165 patients in 2024.
Overview
| NPI | 1053782615 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Oct 8, 2015 |
| Last updated in NPPES | Jun 10, 2025 |
| Certified by provider | Jun 10, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Pharmacy Primary | 333600000X | 16322 | SC |
| Durable Medical Equipment & Medical Supplies | 332B00000X | — | — |
| Pharmacy, Community/Retail Pharmacy | 3336C0003X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled DME Supplier - Pharmacy (SC) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 165 |
|---|---|
| Services billed | 486 across 11 procedure codes |
| Paid by Medicare | $33,139 |
Other pharmacies in Simpsonville
- 1063434710
- 1124121991
- 1184728982
- 1356445159
- 1548275639
- 1699292102
- 1871767566
- 1881858462