# WAL-MART STORES EAST LP

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** WALMART PHARMACY 10-1136
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972520229
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 277-6348

## Contact information

- **Practice address:** 3255 LA HWY 1 S, PORT ALLEN, LA 70767
- **Practice address phone:** (225) 749-7454
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (479) 277-1242

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 4788RC | LA | Yes |

## Other

- **Enumeration date:** 07/16/2006
- **Last updated:** 06/05/2025