Wal-Mart Stores East Lp
NPI 1104297753 · Community/Retail Pharmacy · Horn Lake, MS
Enrolled with Medicare as Dme Supplier - Pharmacy · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Wal-Mart Stores East Lp is a Community/Retail Pharmacy organization in Horn Lake, MS (NPI 1104297753).
Provider details
- NPI number
- 1104297753
- Entity type
- Organization
- Primary specialty
- Community/Retail PharmacySuppliers
- Organization subpart
- No
- Authorized official
- Kimberly Canonic, Senior Director, Enrollment(480) 277-6348
Specialties & taxonomies
Suppliers
Suppliers
- Pharmacy333600000X
Suppliers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure28% of score
10 yrs in NPPES registry
- Profile completeness28% of score
100% of core fields populated
- Practice footprint17% of score
1 documented practice location
- Medicare service volume (vs. specialty peers)28% of score
158 Medicare services, 2024 (ranked within specialty)
Medicare volume is ranked against active providers in the same specialty. Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
What this provider does (Medicare)
Based on Medicare fee-for-service claims, 2024; not all care is captured.
| Service (HCPCS) | Medicare services | Typical Medicare-allowed (2024) |
|---|---|---|
| Administration of Influenza Virus VaccineG0008 | 74 | $21 |
| Admn Sarscov2 Vacc 1 Dose90480 | 60 | $9 |
| Administration of Pneumococcal VaccineG0009 | 24 | $14 |
Typical Medicare-allowed amounts for these services range $9–$21 (2024). The Medicare-allowed amount is what Medicare recognizes for a service under fee-for-service — a reference figure for 2024, not a price quote and not what you would be billed. Medicare Part B covers roughly an eighth of all NPIs (65+ skew); services with fewer than 11 beneficiaries are suppressed by CMS. Source: CMS Medicare Physician & Other Practitioners, by Provider & Service.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Walmart Pharmacy 10-6964
Registry dates
- Enumerated
- 2015-10-08
- Last updated
- 2025-06-09
- Certified
- 2025-06-09
Frequently asked questions
- What is Wal-Mart Stores East Lp's NPI number?
- Wal-Mart Stores East Lp's National Provider Identifier (NPI) is 1104297753, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Wal-Mart Stores East Lp?
- Wal-Mart Stores East Lp is classified in the NPPES registry as Community/Retail Pharmacy (Suppliers).
- Where is Wal-Mart Stores East Lp located?
- Wal-Mart Stores East Lp's practice location on file with NPPES is 4150 Goodman Rd, Horn Lake, MS 38637-0300.
- What is Wal-Mart Stores East Lp's phone number?
- The practice phone number listed in the NPPES registry for Wal-Mart Stores East Lp is (662) 253-6181.
- Does Wal-Mart Stores East Lp accept Medicare?
- Wal-Mart Stores East Lp is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Wal-Mart Stores East Lp?
- The authorized official listed on Wal-Mart Stores East Lp's NPPES record is Kimberly Canonic, Senior Director, Enrollment. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Wal-Mart Stores East Lp's NPI active?
- Yes — Wal-Mart Stores East Lp's NPI (1104297753) is active in the NPPES registry as of the last update on 2025-06-09.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.