Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-0909
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
8101 W JUDGE PEREZ DR, CHALMETTE, LA 70043-1661
(504) 278-2027
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
6215-RC
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1824861
—
LA
01
—
2123260
PK
—
Enumeration date
12/23/2009
Last updated
06/04/2025
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