WAL-MART PHARMACY 10-1773 – Community/Retail Pharmacy, NPI 1376560474

WAL-MART PHARMACY 10-1773 is a healthcare provider. based in Newport news, Virginia. specializing in Community/Retail Pharmacy. The organization holds a License No. 0201003071 (VA). The NPI Number for WAL-MART PHARMACY 10-1773 is 1376560474

Main info

Organization
Name
WAL-MART PHARMACY 10-1773
NPI
1376560474
Phone
(757) 874-4722
Address
12401 JEFFERSON AVE
Authorized Official
KIMBERLY CANONIC CMS ESMD EMDR
Enumeration Date
16 July 2006
Last Update Date
17 June 2025

Contacts

Main Contact
https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience72
Completeness100
Years active:19State licenses:17/7 NPPES fields on file

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Provider Addresses for WAL-MART PHARMACY 10-1773

  • Walmart Supercenter, 12401, Jefferson Avenue, Eastwood, Newport News, Newport News City, Virginia, 23602, United States

    NEWPORT NEWS, VA 236024311

    Phone: (757) 874-4722

    Type: Location

  • Walmart Home Office Main Entrance, 702, Southwest 8th Street, Bentonville, Benton County, Arkansas, 72712, United States

    BENTONVILLE, AR 727160445

    Phone:

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2010-09-30

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Past revalidation due date

Earliest CMS due date was 2024-03-31 (804 days ago).

Enrollment records

1

Earliest due date

2024-03-31

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
O20100930072671OPharmacyVA2024-03-31

What to do next

  • Verify current status on the CMS Revalidation Lookup Tool immediately.
  • Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
  • Overdue revalidation can lead to deactivation of Medicare billing privileges.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
K1034Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count12316$0
G0008Administration of influenza virus vaccine9493$0
90662Influenza vaccine split virus, preservative free9089$0
90480Admn sarscov2 vacc 1 dose6363$0
91322Sarscov2 vac 50 mcg/0.5ml im5959$0
View full utilization report →

Insurance plans in this area (ZIP 23602)

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Reviews

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Frequently asked questions

What identifier follows WAL-MART PHARMACY 10-1773 across health systems?
The NPI 1376560474 uniquely identifies WAL-MART PHARMACY 10-1773 in U.S. healthcare data.
Is WAL-MART PHARMACY 10-1773's NPI status active today?
Active status means WAL-MART PHARMACY 10-1773's NPI record is not deactivated in the public file.
What type of care does WAL-MART PHARMACY 10-1773 provide?
WAL-MART PHARMACY 10-1773's profile centers on Community/Retail Pharmacy. Clinical services aligned with this taxonomy classification.
Is WAL-MART PHARMACY 10-1773 tied to Newport News, Virginia?
If you are local to Newport News, Virginia, WAL-MART PHARMACY 10-1773 may be relevant to your search.
Why is information missing for WAL-MART PHARMACY 10-1773?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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