# WAL-MART STORES EAST LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wal-Mart Pharmacy 10-3042
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134463888
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 277-6348

## Contact information

- **Practice address:** 2800 N HIGHWAY 190, COVINGTON, LA 70433-9049
- **Practice address phone:** (985) 327-6315
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (479) 204-0709
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | PHY006638-RC | LA | Yes |

## Other

- **Enumeration date:** 11/19/2012
- **Last updated:** 06/05/2025