OrganizationActive
Wal-Mart Stores East, Lp
NPI 1124996491 · Pharmacy · Jacksonville, FL
Provider details
- NPI number
- 1124996491
- Entity type
- Organization
- Primary specialty
- PharmacySuppliers
- Organization subpart
- No
- Authorized official
- Kimberly Canonic, Director of Health Care Contracting(480) 277-6348
Specialties & taxonomies
Suppliers
- Community/Retail Pharmacy3336C0003X
Suppliers
Profile Score
Established profile(54/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
Under 1 yr in registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
10000 Omni Dr
Jacksonville, FL 32222-4171
Phone: (904) 934-6904
Approximate (ZIP-level) locationGet directions
Mailing address
1 Customer Dr
Bentonville, AR 72716-0445
Registry dates
- Enumerated
- 2025-10-28
- Last updated
- 2026-04-07
- Certified
- 2026-04-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.