Wal-Mart Stores East LP
NPI 1194172619ActiveOrganization· Pharmacy· La Vergne, TN
Pharmacy in La Vergne, Tennessee, registered in NPPES in May 2016. The authorized official on file is Kimberly Canonic, Senior Director, Enrollment. Medicare paid $17,168 for services to 72 patients in 2024.
Overview
| NPI | 1194172619 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | May 16, 2016 |
| Last updated in NPPES | Jun 10, 2025 |
| Certified by provider | Jun 10, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Pharmacy Primary | 333600000X | 0000005839 | TN |
| Durable Medical Equipment & Medical Supplies | 332B00000X | — | — |
| Pharmacy, Community/Retail Pharmacy | 3336C0003X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled DME Supplier - Pharmacy (TN) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 72 |
|---|---|
| Services billed | 238 across 10 procedure codes |
| Paid by Medicare | $17,168 |
Other Pharmacy providers in La Vergne
- 1164563896
- 1366968778
- 1396750311