Organization · Type 2 NPI

Wal-Mart Stores East LP

Community/Retail Pharmacy · North Port, FL

NPI number 1639540263 Active

Practice location

1100 S Main St
North Port, FL 34287-3500

Call (941) 240-3086 Map

Fax (941) 240-3081

Mailing address

702 SW 8th St, Mailstop 0445
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	PH29603 (FL)

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 …

3 other providers at this address

Other community/retail pharmacy providers in North Port

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NPI record

NPI: 1639540263
Entity type: Organization (Type 2)
Issued: Oct 8, 2015
Last updated: Jun 12, 2025
Status: Active

Other names

<unavail>
Walmart Pharmacy 10-7221 · doing business as
Walmart Pharmacy 10-7221 · doing business as

Authorized official

Kimberly Canonic
Senior Director, Enrollment
(480) 853-0515

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 1639540263

Wal-Mart Stores East LP's National Provider Identifier is 1639540263, issued on Oct 8, 2015. The primary taxonomy on file is Community/Retail Pharmacy (3336C0003X), and the practice location is in North Port, FL. The record was last updated on Jun 12, 2025.