Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-6588
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
3130 PONTCHARTRAIN DR, SLIDELL, LA 70458-4644
(479) 273-4000
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY.007024-RC
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2148073
PK
—
05
—
2203509
—
LA
Enumeration date
09/19/2014
Last updated
06/10/2025
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