MEDICARE: WAL-MART STORES EAST LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PH15383	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2007942	OTHER		PK

General Provider Information

NPI Number	:	1760400618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAL-MART STORES EAST LP

Provider Business Mailing Address
First Line	:	702 SW 8TH ST
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72716-6209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1575 LAND O LAKES BLVD
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33549-2930
Country	:	US
Telephone Number	:	813-949-3664
Fax Number	:

Authorized Official
Title or Position	:	SENIOR DIRECTOR, ENROLLMENT
Name	:	KIMBERLY CANONIC
Credential	:
Telephone Number	:	480-277-6348

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	06/04/2025

Similar Medicare Providers

1760442933 — LINDA S PAEY O.D.
Practice Location Address:

1575 LAND O LAKES BLVD
LUTZ, FL
33549-2930

Practice Phone: 813-909-0678
Practice Fax: 813-909-0270

1265768436 — WAL-MART STORES EAST, LP
Practice Location Address:

1575 LAND O LAKES BLVD
LUTZ, FL
33549-2930

Practice Phone: 813-949-4238
Practice Fax:

1467797076 — MR. SHELDON JAGGERNAUTH RPH
Practice Location Address:

1575 LAND O LAKES BLVD
LUTZ, FL
33549-2930

Practice Phone: 813-949-3664
Practice Fax: 813-949-4238

1346662707 — DR. DAVID MCPARTLAND PHARMD
Practice Location Address:

1575 LAND O LAKES BLVD
LUTZ, FL
33549-2930

Practice Phone: 813-949-3664
Practice Fax: 813-949-4642

1770004806 — DR. BARBARA MADAY CALDERON IZQUIERDO MD
Practice Location Address:

1563 LAND O LAKES BLVD
LUTZ, FL
33549-2930

Practice Phone: 813-949-4224
Practice Fax: 866-372-2717

1902449663 — JENNIFER F HARBOUR APRN
Practice Location Address:

1563 LAND O LAKES BLVD
LUTZ, FL
33549-2930

Practice Phone: 813-856-2946
Practice Fax:

Directions to “WAL-MART STORES EAST LP ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.