WAL-MART STORES EAST, LP
NPI 1700335312
Pharmacy - Community/Retail Pharmacy in Port St Lucie, FL

Active since September 23, 2016CLIA 10D2178684 · Waiver
3045 SW PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34953(772) 301-6124 Get Directions Write a Review

NPPES record last updated: June 12, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jun 12, 2025, May 12, 2017, Sep 23, 2016 (3 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 1700335312), doing business as Walmart Pharmacy 10-5704, is a healthcare organization registered as a community/retail pharmacy in Port St Lucie, Florida and active in the NPI registry since September 2016. The organization holds a CLIA Waiver certificate valid through February 6, 2028 and lists Kimberly Canonic, Senior Director, Enrollment, as its authorized official.

NPPES Registry Identity

NPI1700335312
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameWAL-MART STORES EAST, LP
Location Address3045 SW PORT ST LUCIE BLVDPort St Lucie, FL 34953-0000
Mailing Address702 Sw 8th St, Mailstop 0445Bentonville, AR 72716-0445 · (479) 204-8550 · Fax (479) 277-4331
Organization SubpartYesParent: Wal-mart Stores, Inc.
Authorized OfficialKimberly CanonicSenior Director, Enrollment · (480) 853-0515
Enumeration DateSeptember 23, 2016
Last NPPES UpdateJune 12, 20253 updates tracked since enumeration
NPPES CertifiedJune 12, 2025
NPI 1700335312 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
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
3045 SW PORT ST LUCIE BLVD, Port St Lucie, FL 34953

Other Names 1

Doing Business AsWalmart Pharmacy 10-5704

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 10D2178684

Wal-Mart Stores East LP · Port Saint Lucie, FL
Active · expires Feb 6, 2028
CLIA Number10D2178684
Laboratory TypePharmacy
Certificate Effective DateFebruary 7, 2026
Certificate Expiration DateFebruary 6, 2028
Laboratory DirectorShiny Parsai
Laboratory Phone(772) 301-6124
Laboratory LocationWal-Mart Stores East LP3045 SW Port St Lucie Walmart Pharmacy 10-5704, Port Saint Lucie, FL 34953
CLIA data matches this NPI record on: Name 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 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.
28 services28 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.
27 services27 patients

Medical Equipment Supplier

The provider carries the following medical supplies product categories:

PTAN
20498405
Accepts Medicare Assignment
NO
Specialities List
Pharmacy.
Competitive Bidding
NO

Supplies List

  • 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
  • Blood Glucose Monitors/Supplies (Non-Mail Order) - Home blood glucose monitors including lancets, reagent strips, and other supplies necessary for the proper functioning of the device
  • Blood Glucose Monitors/Supplies (Mail Order) - Home blood glucose monitors including lancets, reagent strips, and other supplies necessary for the proper functioning of the device
  • Ostomy Supplies - Pouches, Paste, Powder, Barrier wipes
  • Enteral Nutrients - Enteral formula
  • Surgical Dressings - Gauze, Elastic bandages, Adhesive tape

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
3045 SW PORT ST LUCIE BLVD
PORT ST LUCIE, FL 34953
Pharmacist
3045 SW PORT ST LUCIE BLVD
PORT ST LUCIE, FL 34953
Pharmacist
3045 SW PORT ST LUCIE BLVD
PORT ST LUCIE, FL 34953

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1700335312, enumerated as an "organization" on September 23, 2016.

The provider is located at 3045 SW PORT ST LUCIE BLVD PORT ST LUCIE, FL 34953 and the phone number is (772) 301-6124.

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.