Organization
WAL-MART STORES EAST , LP
Active
Other names
Walmart Pharmacy 10-7262
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
11550 COURSEY BLVD, BATON ROUGE, LA 70816-4034
(225) 421-3065
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY.007165-RC
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2152626
PK
—
05
—
2203860
—
LA
Enumeration date
05/08/2015
Last updated
06/13/2025
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