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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

WAL-MART STORES EAST, LP
NPI 1124996491
Pharmacy in Jacksonville, FL

Active since October 28, 2025
10000 OMNI DR, JACKSONVILLE, FL 32222(904) 934-6904 Get Directions Write a Review

NPPES record last updated: July 21, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 21, 2026, Apr 7, 2026 (2 updates tracked since 2026).

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 1124996491) is a healthcare organization registered as a pharmacy in Jacksonville, Florida and active in the NPI registry since October 2025. The organization lists Kimberly Canonic, Director Of Health Care Contracting, as its authorized official.

NPPES Registry Identity

NPI1124996491
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameWAL-MART STORES EAST, LP
Location Address10000 OMNI DRJacksonville, FL 32222-4171
Mailing Address1 Customer DrBentonville, AR 72716-0445
Phone(904) 934-6904
Organization SubpartNo
Authorized OfficialKimberly CanonicDirector Of Health Care Contracting · (480) 277-6348
Enumeration DateOctober 28, 2025
Last NPPES UpdateJuly 21, 20262 updates tracked since enumeration
NPPES CertifiedJuly 21, 2026
✔ NPI 1124996491 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
Definition
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.
Also ListedPharmacy · Community/Retail PharmacyTaxonomy 3336C0003X
10000 OMNI DR, Jacksonville, FL 32222
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Other Identifiers 2

Medicaid129973100FL
Medicaid130006400FL

Other Providers at the Same Location NPPES 2

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

ROXANNA MICHELLE NEGRON
Technician/Technologist (Optician)
10000 OMNI DR
JACKSONVILLE, FL 32222
Duval County (904) 934-6920
WAL-MART STORES EAST, LP
Eyewear Supplier
10000 OMNI DR
JACKSONVILLE, FL 32222
Duval County (904) 934-6920

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 1124996491. It was assigned to this organization in the NPPES registry on October 28, 2025.

Where is Wal-Mart Stores East, LP located?

Wal-Mart Stores East, LP is located at 10000 Omni Dr, Jacksonville, FL 32222. The listed phone number is (904) 934-6904.

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

The primary specialty registered for this NPI is Pharmacy with taxonomy code 333600000X.

When was this NPI record last updated?

The NPPES record for Wal-Mart Stores East, LP was last updated on July 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 days 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.