WAL-MART STORES EAST LP
NPI 1154783462
Pharmacy - Community/Retail Pharmacy in Labelle, FL

Active since March 25, 2016CLIA 10D2188586 · Waiver
1951 W HICKPOCHEE AVE, LABELLE, FL 33935(863) 302-6009(863) 302-6008 Get Directions Write a Review

NPPES record last updated: June 9, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jun 9, 2025, Feb 15, 2017, Jan 18, 2017 and 6 more (9 updates tracked since 2016).

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 1154783462), doing business as Walmart Pharmacy 10-6190, is a healthcare organization registered as a community/retail pharmacy in Labelle, Florida and active in the NPI registry since March 2016. The organization holds a CLIA Waiver certificate valid through July 19, 2028 and lists Kimberly Canonic, Senior Director, Enrollment, as its authorized official.

NPPES Registry Identity

NPI1154783462
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameWAL-MART STORES EAST LP
Location Address1951 W HICKPOCHEE AVELabelle, FL 33935-4792
Mailing Address702 Sw 8th St, Mailstop 0445Bentonville, AR 72716-0445 · (479) 204-1258 · Fax (479) 277-4331
Fax(863) 302-6008
Organization SubpartNo
Authorized OfficialKimberly CanonicSenior Director, Enrollment · (480) 277-6348
Enumeration DateMarch 25, 2016
Last NPPES UpdateJune 9, 20259 updates tracked since enumeration
NPPES CertifiedJune 9, 2025
NPI 1154783462 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 · PH30020
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
1951 W HICKPOCHEE AVE, Labelle, FL 33935

Other Names 1

Doing Business AsWalmart Pharmacy 10-6190

Other Identifiers 3

Medicaid017328601FL
Other2159070Pk
Medicaid017328600FL

Accepted 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 10D2188586

Wal-Mart Stores East LP · Labelle, FL
Active · expires Jul 19, 2028
CLIA Number10D2188586
Laboratory TypePharmacy
Certificate Effective DateJuly 20, 2026
Certificate Expiration DateJuly 19, 2028
Laboratory DirectorDaiyan Ibrahim
Laboratory Phone(239) 645-8438
Laboratory LocationWal-Mart Stores East LP1951 W Hickpochee Ave, Labelle, FL 33935
CLIA data matches this NPI record on: Address 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 2024 & 2026 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.
132 services126 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.
123 services119 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.
25 services25 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.
14 services14 patients

Other Providers at the Same Location NPPES 3

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

Pharmacist
1951 W HICKPOCHEE AVE
LABELLE, FL 33935
Eyewear Supplier
1951 W HICKPOCHEE AVE
LABELLE, FL 33935
Technician/Technologist (Optician)
1951 W HICKPOCHEE AVE
LABELLE, FL 33935

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1154783462, enumerated as an "organization" on March 25, 2016.

The provider is located at 1951 W HICKPOCHEE AVE LABELLE, FL 33935 and the phone number is (863) 302-6009.

Pharmacy with taxonomy code 3336C0003X and a focus in Community/Retail Pharmacy.

The provider might be accepting Accepts: Alliant Health Plans, Inc., Ambetter from Absolute. Please consult your insurance carrier or call the provider to verify.