Wal-Mart Stores East, LP

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

WAL-MART STORES EAST, LP

Doing business as

Walmart Pharmacy 10-2779

Practice address

41176 Hwy 27
Davenport, FL 33837-1005

Phone

(479) 277-3665

NPI assigned

Sep 17, 2026

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

Director of Health Care Contracting

Phone

(480) 853-0515

Specialties & licenses 3

Addresses

Other names 1

• Walmart Pharmacy 10-2779 Doing business as

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

{
    "created_epoch": "1789603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789603200000",
    "number": "1235041054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CUSTOMER DR # MS 0445",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445",
            "telephone_number": "479-277-3665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41176 HWY 27",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338371005",
            "telephone_number": "479-277-3665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES EAST, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-17",
        "last_updated": "2026-09-17",
        "certification_date": "2026-09-16",
        "status": "A",
        "authorized_official_last_name": "CANONIC",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "DIRECTOR OF HEALTH CARE CONTRACTING",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walmart Pharmacy 10-2779",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Matthew Volker, LMHC
• Wolf Karl Von Waagner, MD
• Wal-Mart Stores East, LP (Walmart Vision Center 30-2779)
• Walgreen Co (Walgreens # 11104)
• Walgreen Co (Walgreens #06217)
• Cleveland Wallace
• Kaysey Wann, MA, EDM, NCSP, LSP

• Pharmacy in Davenport, FL
• Providers in Davenport, FL by specialty
• Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.