Organization · Type 2 NPI

Wal-Mart Stores East LP

Community/Retail Pharmacy · St. Augustine, FL

NPI number 1407873714 Active

Practice location

2355 US Highway 1 S
St. Augustine, FL 32086-6072

Call (904) 794-4134 Map

Mailing address

702 SW 8th St
Bentonville, AR 72716-0445

Specialties and licenses

Taxonomy	Code	License
Durable Medical Equipment & Medical Supplies	332B00000X	None listed
Pharmacy	333600000X	None listed
Community/Retail Pharmacy Primary	3336C0003X	PH15457 (FL)
Specialty Pharmacy	3336S0011X	None listed

Community/Retail Pharmacy: 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 …

Another provider at this address

Wal-Mart Stores East, LPEyewear Supplier St. Augustine, FL NPI 1740388842

Other community/retail pharmacy providers in St. Augustine

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NPI record

NPI: 1407873714
Entity type: Organization (Type 2)
Issued: Jul 16, 2006
Last updated: Jun 2, 2025
Status: Active

Other names

<unavail>
Walmart Pharmacy 10-0579 · doing business as
Walmart Pharmacy 10-0579 · doing business as

Authorized official

Kimberly Canonic
Senior Director, Enrollment
(480) 277-6348

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1407873714

Wal-Mart Stores East LP's National Provider Identifier is 1407873714, issued on Jul 16, 2006. The primary taxonomy on file is Community/Retail Pharmacy (3336C0003X), and the practice location is in St. Augustine, FL. The record was last updated on Jun 2, 2025.