WAL-MART STORES EAST LP
NPI 1215948732
Pharmacy - Community/Retail Pharmacy in Daytona Beach, FL

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

The NPI number for Wal-Mart Stores East LP is 1215948732. It was assigned to this organization in the NPPES registry on August 10, 2006. The provider is doing business as Walmart Pharmacy 10-3862.

Q: 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.

Active since August 10, 2006CLIA Certified · 2 labs

1905 N NOVA RD, DAYTONA BEACH, FL 32117(386) 672-8955(479) 277-4331 Get Directions Write a Review

NPPES record last updated: July 8, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 8, 2025, Dec 22, 2021, Jul 19, 2018 and 2 more (5 updates tracked since 2017).

On this page

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 1215948732), doing business as Walmart Pharmacy 10-3862, is a healthcare organization registered as a community/retail pharmacy in Daytona Beach, Florida and active in the NPI registry since August 2006. The organization holds 2 active CLIA laboratory certificates and lists Kimberly Canonic, Senior Director, Enrollment, as its authorized official.

NPPES Registry Identity

NPI1215948732

Entity TypeOrganization

Primary Taxonomy3336C0003X

Legal Business NameWAL-MART STORES EAST LP

Location Address1905 N NOVA RDDaytona Beach, FL 32117-1421

Mailing Address702 Sw 8th StBentonville, AR 72716-0445

Phone(386) 672-8955

Fax(479) 277-4331

Organization SubpartNo

Authorized OfficialKimberly CanonicSenior Director, Enrollment · (480) 853-0515

Enumeration DateAugust 10, 2006

Last NPPES UpdateJuly 8, 20255 updates tracked since enumeration

NPPES CertifiedJuly 8, 2025

✔ NPI 1215948732 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers

Taxonomy Code3336C0003X

License✔ Licensed in FL · PH22245

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

1905 N NOVA RD, Daytona Beach, FL 32117

Open in Google Maps ↗

Other Names 1

Doing Business AsWalmart Pharmacy 10-3862

Other Identifiers 2

Other2007006Pk

Medicaid031721700FL

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 10D2283415

Wal-Mart Stores East LP · Holly Hill, FL

Active · expires Jun 6, 2027

CLIA Number10D2283415

Laboratory TypePharmacy

Certificate Effective DateJune 7, 2025

Certificate Expiration DateJune 6, 2027

Laboratory DirectorChristopher Bowra

Laboratory Phone(386) 672-8955

Laboratory LocationWal-Mart Stores East LP1905 Nova Rd, Holly Hill, FL 32117

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2180168

Wal-Mart Store East, LP · Orlando, FL

Active · expires Mar 8, 2028

CLIA Number10D2180168

Laboratory TypePharmacy

Certificate Effective DateMarch 9, 2026

Certificate Expiration DateMarch 8, 2028

Laboratory DirectorJason Mandernach

Laboratory Phone(386) 672-8955

Laboratory LocationWal-Mart Store East, LP2715 S Orange Ave, Orlando, FL 32806

CLIA data matches this NPI record on: 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.

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.

30 services29 patients

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.

30 services29 patients

Medical Equipment Supplier Medicare DMEPOS 11

Medicare supplier enrollment and the product categories Walmart Pharmacy 10-3862 carries, from the Medicare DMEPOS supplier directory.

Walmart Pharmacy 10-3862

DMEPOS supplier · Daytona Beach, FLOperated by Wal-Mart Stores East, LP

⋮

Does not accept Medicare assignment

Walmart Pharmacy 10-3862 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)20497397

Medicare Participant SinceJuly 1, 2014

Supplier Location1905 N Nova RdDaytona Beach, FL 32117

Phone(386) 672-8955

Supplier Specialties

Pharmacy

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 2

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

DR. JONAH KOBELIN PHARMD, RPH, CPH

Pharmacist

1905 N NOVA RD
HOLLY HILL, FL 32117

Volusia County (386) 672-8955

DR. DEIZENMAI N GEH PHARMD

Pharmacist

1905 N NOVA RD
DAYTONA BEACH, FL 32117

Volusia County (386) 672-8955

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 1215948732. It was assigned to this organization in the NPPES registry on August 10, 2006. The provider is doing business as Walmart Pharmacy 10-3862.

Where is Wal-Mart Stores East LP located?

Wal-Mart Stores East LP is located at 1905 N Nova Rd, Daytona Beach, FL 32117. The listed phone number is (386) 672-8955.

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, Walmart Pharmacy 10-3862 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 51 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 8, 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.