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WAL-MART STORES EAST LP
NPI 1124045331
Pharmacy - Community/Retail Pharmacy in Pace, FL

Active since July 16, 2006CLIA Certified · 2 labs
4965 HIGHWAY 90, PACE, FL 32571(850) 995-5115 Get Directions Write a Review

NPPES record last updated: June 4, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 4, 2025, Feb 16, 2017 (2 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 1124045331), doing business as Walmart Pharmacy 10-0990, is a healthcare organization registered as a community/retail pharmacy in Pace, Florida and active in the NPI registry since July 2006. The organization holds 2 active CLIA laboratory certificates and lists Kimberly Canonic, Senior Director, Enrollment, as its authorized official.

NPPES Registry Identity

NPI1124045331
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameWAL-MART STORES EAST LP
Location Address4965 HIGHWAY 90Pace, FL 32571-1408
Mailing Address702 Sw 8th StBentonville, AR 72716-6209 · (479) 277-1242
Phone(850) 995-5115
Organization SubpartNo
Authorized OfficialKimberly CanonicSenior Director, Enrollment · (480) 277-6348
Enumeration DateJuly 16, 2006
Last NPPES UpdateJune 4, 20252 updates tracked since enumeration
NPPES CertifiedJune 4, 2025
✔ NPI 1124045331 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in FL · PH15369
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
4965 HIGHWAY 90, Pace, FL 32571
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Other Names 1

Doing Business AsWalmart Pharmacy 10-0990

Other Identifiers 2

Medicaid109514500FL
Other2007891Pk

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 2

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 10D2190899

Wal-Mart Stores East, LP · Milton, FL
Active · expires Aug 19, 2026
CLIA Number10D2190899
Laboratory TypePharmacy
Certificate Effective DateAugust 20, 2024
Certificate Expiration DateAugust 19, 2026
Laboratory DirectorTristan Cox
Laboratory Phone(850) 995-5115
Laboratory LocationWal-Mart Stores East, LP4965 Highway 90, Milton, FL 32571
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2325790

Wal-Mart Stores East, LP · Pace, FL
Active · expires Jun 19, 2027
CLIA Number10D2325790
Laboratory TypePharmacy
Certificate Effective DateJune 20, 2025
Certificate Expiration DateJune 19, 2027
Laboratory DirectorThomas Norton
Laboratory Phone(479) 371-2991
Laboratory LocationWal-Mart Stores East, LP4329 Berryhill Rd, Pace, FL 32571
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 4

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.
190 services188 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.
177 services175 patients
Administration of pneumococcal vaccine G0009
The pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.
36 services36 patients
Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use 90677
The Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.
19 services19 patients

Medical Equipment Supplier Medicare DMEPOS 12

Medicare supplier enrollment and the product categories Wal-Mart Stores East, LP carries, from the Medicare DMEPOS supplier directory.

Wal-Mart Stores East, LP

DMEPOS supplier · Pace, FL
⋮

Does not accept Medicare assignment

Wal-Mart Stores East, LP has not agreed to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients may be charged more than the Medicare-approved amount; confirm the expected cost with the supplier before ordering.

PTAN (Medicare Supplier Number)20500907
Medicare Participant SinceJuly 1, 2014
Supplier Location4965 Highway 90Pace, FL 32571
Phone(850) 995-5115
Supplier Specialties
Pharmacy Optician

Medicare Product Categories

Epoetin
Epoetin is a man-made version of human erythropoietin (EPO)
Immunosuppressive Drugs
Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
Infusion Drugs
Nebulizer Drugs
Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
Oral Anticancer Drugs
FDA anticancer drugs
Oral Antiemetic Drugs
FDA antiemetic drugs
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Other Providers at the Same Location NPPES 7

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

DR. TIFFANY ALESE COOPER PHARMD
Pharmacist
4965 HIGHWAY 90
PACE, FL 32571
Santa Rosa County (850) 995-8018
WAL-MART STORES EAST, LP
Eyewear Supplier
4965 HIGHWAY 90
MILTON, FL 32571
Santa Rosa County (850) 995-0542
ASHLEY NICOLE DAMM PHARMD
Pharmacist
4965 HIGHWAY 90
MILTON, FL 32571
Santa Rosa County (850) 995-5115
DR. MATTHEW LOPEZ PHARM D
Pharmacist
4965 HIGHWAY 90
PACE, FL 32571
Santa Rosa County (850) 995-5115
DR. JEFFREY ADAM SCOTT PHARMD
Pharmacist
4965 HIGHWAY 90
PACE, FL 32571
Santa Rosa County (850) 995-5115
MARIA ELENA VILLARREAL LDO
Technician/Technologist (Optician)
4965 HIGHWAY 90
MILTON, FL 32571
Santa Rosa County (850) 995-1428
DR. JOHN HELMY HANNA NEAMATALLA PHARM D
Pharmacist
4965 HIGHWAY 90
PACE, FL 32571
Santa Rosa County (850) 995-5115

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 1124045331. It was assigned to this organization in the NPPES registry on July 16, 2006. The provider is doing business as Walmart Pharmacy 10-0990.

Where is Wal-Mart Stores East LP located?

Wal-Mart Stores East LP is located at 4965 Highway 90, Pace, FL 32571. The listed phone number is (850) 995-5115.

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 accept Medicare assignment for medical equipment?

No. As a Medicare medical equipment supplier, Wal-Mart Stores East, LP does not accept Medicare assignment for equipment and supplies, so patients may be charged more than the Medicare-approved amount. Confirm the expected cost with the supplier before ordering.

Does Wal-Mart Stores East LP hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

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 June 4, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.