# WAL-MART STORES EAST LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WalMart Pharmacy 10-0803
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962717157
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 277-6348

## Contact information

- **Practice address:** 401 ONTARIO AVE, BOGALUSA, LA 70427-2610
- **Practice address phone:** (985) 732-7677
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (479) 277-1242
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHY006282-RC | LA | Yes |

## Other

- **Enumeration date:** 08/11/2010
- **Last updated:** 06/03/2025