# WAL-MART STORES EAST LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Walmart Pharmacy 10-6583
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780055301
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 277-6348

## Contact information

- **Practice address:** 2011 RYAN ST, LAKE CHARLES, LA 70601-7313
- **Practice address phone:** (337) 508-3867
- **Practice address fax:** (337) 508-3868
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-6209
- **Mailing address phone:** (479) 204-8550
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHY.007231-RC | LA | Yes |

## Other

- **Enumeration date:** 10/08/2015
- **Last updated:** 06/10/2025