Wal-Mart Stores East LP

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH22176 Issued in FL

Legal business name

WAL-MART STORES EAST LP

Doing business as

Walmart Pharmacy 10-3311

Practice address

19501 NW 27TH Ave
Miami Gardens, FL 33056-2521

Phone

(305) 622-6668

Fax

(479) 277-4331

NPI assigned

Aug 27, 2006

Last updated

Jun 19, 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

(480) 853-0515

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• WALMART PHARMACY 10-3311 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.

CLIA laboratory certificates

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 24

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

• Wal-Mart Store East, LP

  dba Vision Center 30-2176

  • Optician
  • Jupiter, FL
  • NPI 1205928769
  NPD tax ID
• Wal-Mart Stores East LP

  dba WalMart Pharmacy 10-5911

  • Community/Retail Pharmacy
  • Boynton Beach, FL
  • NPI 1184904351
  NPD tax ID
• Wal-Mart Stores East LP

  dba Walmart Pharmacy 10-4159

  • Community/Retail Pharmacy
  • Kissimmee, FL
  • NPI 1194135947
  NPD tax ID
• Wal-Mart Stores East LP

  dba Walmart Pharmacy 10-5266

  • Community/Retail Pharmacy
  • Hudson, FL
  • NPI 1194901520
  NPD tax ID
• Wal-Mart Stores East LP

  • Community/Retail Pharmacy
  • Orlando, FL
  • NPI 1205018934
  NPD tax ID
• Wal-Mart Stores East LP

  dba Walmart Pharmacy 10-5453

  • Community/Retail Pharmacy
  • Cape Coral, FL
  • NPI 1205044187
  NPD tax ID
• Wal-Mart Stores East LP

  dba WalMart Pharmacy 10-5894

  • Community/Retail Pharmacy
  • Oviedo, FL
  • NPI 1205107802
  NPD tax ID
• Wal-Mart Stores East LP

  dba Walmart Pharmacy 10-1845

  • Community/Retail Pharmacy
  • Cooper City, FL
  • NPI 1205853686
  NPD tax ID
• Wal-Mart Stores East LP

  dba Walmart Pharmacy 10-3308

  • Community/Retail Pharmacy
  • Middleburg, FL
  • NPI 1205926276
  NPD tax ID
• Wal-Mart Stores East LP

  dba Walmart Pharmacy 10-3877

  • Community/Retail Pharmacy
  • Gainesville, FL
  • NPI 1215119946
  NPD tax ID
• Wal-Mart Stores East LP

  dba Walmart Pharmacy 10-3862

  • Community/Retail Pharmacy
  • Daytona Beach, FL
  • NPI 1215948732
  NPD tax ID
• Wal-Mart Stores East LP

  dba Walmart Pharmacy 10-0967

  • Community/Retail Pharmacy
  • Spring Hill, FL
  • NPI 1215954425
  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

Networks

• HealthSun Health Plans Network

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

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750291200000",
    "number": "1205944691",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19501 NW 27TH AVE",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "330562521",
            "telephone_number": "305-622-6668",
            "fax_number": "479-277-4331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES EAST LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-27",
        "last_updated": "2025-06-19",
        "certification_date": "2025-06-19",
        "status": "A",
        "authorized_official_last_name": "CANONIC",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "SENIOR DIRECTOR, ENROLLMENT",
        "authorized_official_telephone_number": "480-853-0515"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH22176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "031655500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2006893",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "031655501",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.22.16.840.1.113883.3.667.2",
            "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 10-3311",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Walgreen Co (Walgreens #04917)
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• Community/Retail Pharmacy in Miami Gardens, FL
• Providers in Miami Gardens, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 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.