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WAL-MART STORES EAST LP
NPI 1104844547
Pharmacy - Community/Retail Pharmacy in Jacksonville, FL

Active since July 17, 2006CLIA 10D2192583 · Waiver
13227 CITY SQUARE DR, JACKSONVILLE, FL 32218(904) 751-5141(479) 277-4331 Get Directions Write a Review

NPPES record last updated: July 7, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 7, 2025, May 11, 2023, Jul 19, 2018 and 2 more (5 updates tracked since 2017).

About Wal-mart Stores East Lp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WAL-MART STORES EAST LP (NPI 1104844547), doing business as Walmart Pharmacy 10-3702, is a healthcare organization registered as a community/retail pharmacy in Jacksonville, Florida and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through September 10, 2026 and lists Kimberly Canonic, Senior Director, Enrollment, as its authorized official.

NPPES Registry Identity

NPI1104844547
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameWAL-MART STORES EAST LP
Location Address13227 CITY SQUARE DRJacksonville, FL 32218-7218
Mailing Address702 Sw 8th StBentonville, AR 72716-0445 · (479) 277-1242
Phone(904) 751-5141
Fax(479) 277-4331
Organization SubpartNo
Authorized OfficialKimberly CanonicSenior Director, Enrollment · (480) 277-6348
Enumeration DateJuly 17, 2006
Last NPPES UpdateJuly 7, 20255 updates tracked since enumeration
NPPES CertifiedJuly 7, 2025
✔ NPI 1104844547 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in FL · PH21970
Definition
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X
Also ListedPharmacyTaxonomy 333600000X
Also ListedPharmacy · Specialty PharmacyTaxonomy 3336S0011X
13227 CITY SQUARE DR, Jacksonville, FL 32218
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Other Names 1

Doing Business AsWalmart Pharmacy 10-3702

Other Identifiers 3

Other2006619Pk
Medicaid031419601FL
Medicaid031419600FL

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2192583

Wal-Mart Stores East LP · Jacksonville, FL
Active · expires Sep 10, 2026
CLIA Number10D2192583
Laboratory TypePharmacy
Certificate Effective DateSeptember 11, 2024
Certificate Expiration DateSeptember 10, 2026
Laboratory DirectorJennifer Coachman
Laboratory Phone(904) 751-5141
Laboratory LocationWal-Mart Stores East LP13227 City Square Dr, Jacksonville, FL 32218
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
60 services59 patients
Influenza vaccine split virus, preservative free 90662
The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
54 services54 patients

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PAUL VISION CARE LLC
Optometrist
13227 CITY SQUARE DR, WALMART VISION CENTER
JACKSONVILLE, FL 32218
Duval County (904) 696-1433
MOLLY CROSBY
Technician/Technologist (Optician)
13227 CITY SQUARE DR
JACKSONVILLE, FL 32218
Duval County (904) 751-5611
DR. ADELE DEBRA PAUL O.D.
Optometrist
13227 CITY SQUARE DR
JACKSONVILLE, FL 32218
Duval County (904) 696-1433
JENNIFER LYNN COACHMAN PHARMD
Pharmacist
13227 CITY SQUARE DR
JACKSONVILLE, FL 32218
Duval County (904) 751-5141

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Wal-Mart Stores East LP's NPI number?

The NPI number for Wal-Mart Stores East LP is 1104844547. It was assigned to this organization in the NPPES registry on July 17, 2006. The provider is doing business as Walmart Pharmacy 10-3702.

Where is Wal-Mart Stores East LP located?

Wal-Mart Stores East LP is located at 13227 City Square Dr, Jacksonville, FL 32218. The listed phone number is (904) 751-5141.

What is Wal-Mart Stores East LP's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Does Wal-Mart Stores East LP hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2192583) is associated with this NPI, valid through September 10, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Wal-Mart Stores East LP accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arizona Complete Health and 50 other insurers list Wal-Mart Stores East LP as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Wal-Mart Stores East LP was last updated on July 7, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.