WAL-MART STORES EAST LP NPI 1205853686

NPI Details

WAL-MART STORES EAST LP is a community/retail pharmacy pharmacy in Cooper City, FL. The provider is 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 health care providers, collaborative practice, disease state management, and education classes. WAL-MART STORES EAST LP NPI is 1205853686. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

4700 S FLAMINGO RD
COOPER CITY, FL
ZIP 33330-300
Phone: (954) 680-7821

The provider's authorized official is Kimberly Canonic .
The authorized official title is Senior Director, Enrollment and has the following contact phone number (480) 853-0515.

The CLIA number assigned to this NPI record is 10D2190035 - pharmacy with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

• Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count (HCPCS:K1034)
• Administration of influenza virus vaccine (HCPCS:G0008)
• Influenza vaccine split virus, preservative free (HCPCS:90662)
• Fee covid-19 vac 13 res (HCPCS:0124A)
• Adm sarscv2 30mcg trs-sucr 1 (HCPCS:0051A)
• Adm sarscov2 50mcg/0.25mlbst (HCPCS:0064A)
• Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use (HCPCS:90677)
• Adm sarscv2 30mcg trs-sucr b (HCPCS:0054A)
• Fee covid-19 vac 14 res (HCPCS:0134A)
• Administration of pneumococcal vaccine (HCPCS:G0009)

The enumeration date for this NPI number is 7/16/2006 and was last updated on 6/16/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.