Organization · Type 2 NPI

Wal-Mart Stores East, LP

Community/Retail Pharmacy · St. Johns, FL

NPI number 1629558937 Active

Practice location

845 Durbin Pavilion Dr
St. Johns, FL 32259-0000

Call (479) 277-9170 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
Community/Retail Pharmacy Primary	3336C0003X	None listed
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 …

4 other providers at this address

Other community/retail pharmacy providers in St. Johns

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NPI record

NPI: 1629558937
Entity type: Organization (Type 2)
Issued: Aug 16, 2018
Last updated: Jun 4, 2025
Status: Active

Other names

<unavail>
Walmart Pharmacy 10-0928 · doing business as
Walmart Pharmacy 10-0928 · doing business as

Authorized official

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

Verify this record

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 1629558937

Wal-Mart Stores East, LP's National Provider Identifier is 1629558937, issued on Aug 16, 2018. The primary taxonomy on file is Community/Retail Pharmacy (3336C0003X), and the practice location is in St. Johns, FL. The record was last updated on Jun 4, 2025.