Wal-Mart Stores East LP

Primary specialty

Specialty PharmacyTaxonomy code 3336S0011X

License

OS01543 Issued in AR

Legal business name

WAL-MART STORES EAST LP

Doing business as

Walmart Pharmacy 10-5315

Practice address

2354 Commerce Park Dr Ste 100
Orlando, FL 32819-8601

Phone

(877) 453-4566

Fax

(866) 537-0877

NPI assigned

Jul 16, 2006

Last updated

Jun 12, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kimberly Canonic

Title

Senior Director, Enrollment

Phone

(479) 371-1168

Specialties & licenses 15

Addresses

Other identifiers 12

Other names 1

• WALMART PHARMACY 10-5315 Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

Ability Network4,654 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Wal-Mart Stores East LP

  dba Wal-Mart Pharmacy 10-3606

  • Pharmacy
  • Debary, FL
  • NPI 1003363052
  NPD tax ID
• Wal-Mart Stores East LP

  dba WalMart Pharmacy 10-5622

  • Community/Retail Pharmacy
  • Riverview, FL
  • NPI 1013287499
  NPD tax ID
• Wal-Mart Stores East LP

  dba Walmart Pharmacy 10-0814

  • Community/Retail Pharmacy
  • Okeechobee, FL
  • NPI 1023035417
  NPD tax ID
• Wal-Mart Stores East LP

  dba Walmart Pharmacy 10-3349

  • Community/Retail Pharmacy
  • Port Charlotte, FL
  • NPI 1023126414
  NPD tax ID
• Wal-Mart Stores East LP

  dba WalMart Pharmacy 10-5945

  • Community/Retail Pharmacy
  • Hialeah, FL
  • NPI 1023388402
  NPD tax ID
• Wal-Mart Stores East LP

  dba Walmart Pharmacy 10-0931

  • Community/Retail Pharmacy
  • Vero Beach, FL
  • NPI 1033136247
  NPD tax ID
• Wal-Mart Stores East LP

  dba Wal-Mart Pharmacy 10-1222

  • Community/Retail Pharmacy
  • Pensacola, FL
  • NPI 1033136403
  NPD tax ID
• Wal-Mart Stores East LP

  dba Walmart Pharmacy 10-0582

  • Community/Retail Pharmacy
  • Port Orange, FL
  • NPI 1033136411
  NPD tax ID
• Wal-Mart Stores East LP

  dba Walmart Pharmacy 10-1960

  • Community/Retail Pharmacy
  • Tampa, FL
  • NPI 1033136429
  NPD tax ID
• Wal-Mart Stores East LP

  dba Walmart Pharmacy 10-2920

  • Community/Retail Pharmacy
  • Orange Park, FL
  • NPI 1033136437
  NPD tax ID
• Wal-Mart Stores East LP

  dba Walmart Pharmacy 10-1082

  • Community/Retail Pharmacy
  • Jacksonville, FL
  • NPI 1033136528
  NPD tax ID
• Wal-Mart Stores East, LP

  dba Vision Center 30-2626

  • Eyewear Supplier
  • Live Oak, FL
  • NPI 1013009554
  NPD tax ID

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Sams East Inc

  dba Sams Pharmacy 10-8256

  • Community/Retail Pharmacy
  • Knoxville, TN
  • NPI 1265459465

  Member Of

  NPD member
• Walmart Inc.

  dba Walmart Pharmacy 10-1588

  • Community/Retail Pharmacy
  • Victorville, CA
  • NPI 1043237456

  Member Of

  NPD member

Locations

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Anthony Aloi, RPH

  • Pharmacist
  • Lake Mary, FL
  • NPI 1124297577
  NPD (past)
• Christopher Creary, PHARMD

  • Pharmacist
  • Orlando, FL
  • NPI 1467055749
  NPD (past)
• Demetria Griffin, PHARMD

  • Pharmacist
  • Orlando, FL
  • NPI 1487196093
  NPD (past)
• Paul Koerner

  • Pharmacist
  • Orlando, FL
  • NPI 1023565066
  NPD (past)
• Vu Lam

  • Pharmacist
  • Orlando, FL
  • NPI 1861095804
  NPD (past)
• Timothy McDermott

  • Pharmacist
  • Orlando, FL
  • NPI 1770186199
  NPD (past)
• Christine Ramirez, PHARMD

  • Pharmacist
  • Orlando, FL
  • NPI 1215560917
  NPD (past)
• Patricia Romero

  • Pharmacist
  • Orlando, FL
  • NPI 1659974038
  NPD (past)
• Brenda Marcella Waskiewicz

  • Pharmacist
  • Orlando, FL
  • NPI 1447854344
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

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    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749686400000",
    "number": "1013934413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SW 8TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445",
            "telephone_number": "479-277-1242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2354 COMMERCE PARK DR STE 100",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328198601",
            "telephone_number": "877-453-4566",
            "fax_number": "866-537-0877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES EAST LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2025-06-12",
        "certification_date": "2025-06-12",
        "status": "A",
        "authorized_official_last_name": "CANONIC",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "SENIOR DIRECTOR, ENROLLMENT",
        "authorized_official_telephone_number": "479-371-1168"
    },
    "taxonomies": [
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
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        },
        {
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        },
        {
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            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "MN",
            "license": "262265",
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
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            "state": "KY",
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        {
            "code": "3336S0011X",
            "taxonomy_group": "",
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            "state": "IL",
            "license": "054.015021",
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        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
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        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "IN",
            "license": "64000468A",
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "LA",
            "license": "PHY.005063-OS",
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "TX",
            "license": "22601",
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "TN",
            "license": "3872",
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "MI",
            "license": "5301007714",
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "MO",
            "license": "2003010214",
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "OK",
            "license": "99-6096",
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "FL",
            "license": "PH18943",
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "OH",
            "license": "021368750-03",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006340",
            "state": "FL"
        },
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            "issuer": null,
            "identifier": "025831800",
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            "code": "05",
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            "issuer": null,
            "identifier": "0311413",
            "state": "NJ"
        },
        {
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            "issuer": null,
            "identifier": "1013934413",
            "state": "AL"
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            "identifier": "25831800",
            "state": "FL"
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        {
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            "issuer": null,
            "identifier": "80658873",
            "state": "CO"
        },
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            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2015188",
            "state": null
        },
        {
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            "identifier": "3810010863",
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            "issuer": null,
            "identifier": "1007455310380",
            "state": "PA"
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        {
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            "issuer": null,
            "identifier": "100445350C",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100505069",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "WALMART PHARMACY 10-5315",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WALMART PHARMACY 10-5315",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lisa J Waizenegger, M.D.
• Gabriel Wajner, D.C.
• Wake Up Mentoring, Inc.
• Hannah Wakeman
• Joseph Antoine Wakim, DDS
• Wal-Mart Stores East LP (Walmart Pharmacy 10-5988)
• Wal-Mart Stores East LP (Walmart Pharmacy 10-5741)
• Wal-Mart Stores East LP (Walmart Pharmacy 10-3617)
• Wal-Mart Stores East LP (Walmart Pharmacy 10-3817)
• Wal-Mart Stores East LP

• Specialty Pharmacy in Orlando, FL
• Providers in Orlando, FL by specialty
• Specialty Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.