OrganizationActive
Wal-Mart Stores East Lp
NPI 1194135947 · Community/Retail Pharmacy · Kissimmee, FL
Provider details
- NPI number
- 1194135947
- Entity type
- Organization
- Primary specialty
- Community/Retail PharmacySuppliers
- Organization subpart
- No
- Authorized official
- Kimberly Canonic, Senior Director, Enrollment(480) 277-6348
Specialties & taxonomies
Suppliers
Suppliers
- Specialty Pharmacy3336S0011X
Suppliers
Profile Score
Detailed profile(76/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
12 yrs in NPPES 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
2850 E Osceola Pkwy
Kissimmee, FL 34743-6027
Phone: (407) 552-0036
Street-level locationGet directions
Mailing address
702 Sw 8th St
Bentonville, AR 72716-0445
Other names (DBA / former)
- Doing business as
- Walmart Pharmacy 10-4159
- Doing business as
- Walmart Pharmacy 10-4159
Registry dates
- Enumerated
- 2014-05-02
- Last updated
- 2025-06-06
- Certified
- 2025-06-06
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.