WAL-MART STORES EAST LP
NPI 1497772602
Pharmacy - Community/Retail Pharmacy in Indian Harbour Beach, FL

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

The NPI number for Wal-Mart Stores East LP is 1497772602. It was assigned to this organization in the NPPES registry on July 16, 2006. The provider is doing business as Walmart Pharmacy 10-0956.

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 July 16, 2006CLIA 10D2180105 · Waiver

1001 E EAU GALLIE BLVD, INDIAN HARBOUR BEACH, FL 32937(321) 773-0663 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).

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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 1497772602), doing business as Walmart Pharmacy 10-0956, is a healthcare organization registered as a community/retail pharmacy in Indian Harbour Beach, Florida and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through March 5, 2028 and lists Kimberly Canonic, Senior Director, Enrollment, as its authorized official.

NPPES Registry Identity

NPI1497772602

Entity TypeOrganization

Primary Taxonomy3336C0003X

Legal Business NameWAL-MART STORES EAST LP

Location Address1001 E EAU GALLIE BLVDIndian Harbour Beach, FL 32937-4907

Mailing Address702 Sw 8th StBentonville, AR 72716-0445

Phone(321) 773-0663

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 1497772602 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 · PH15446

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

1001 E EAU GALLIE BLVD, Indian Harbour Beach, FL 32937

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Other Names 1

Doing Business AsWalmart Pharmacy 10-0956

Other Identifiers 2

Medicaid109408400FL

Other2007864Pk

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 10D2180105

Wal-Mart Store East, LP · Melbourne, FL

Active · expires Mar 5, 2028

CLIA Number10D2180105

Laboratory TypePharmacy

Certificate Effective DateMarch 6, 2026

Certificate Expiration DateMarch 5, 2028

Laboratory DirectorThea Yates

Laboratory Phone(321) 773-0663

Laboratory LocationWal-Mart Store East, LP1001 E Eau Gallie Blvd, Melbourne, FL 32937

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 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.

216 services214 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.

211 services209 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.

22 services22 patients

Other Providers at the Same Location NPPES 5

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

RUBEN OLIVEIRA

Pharmacist