Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-5327
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
9830 OLD HAMMOND HWY, BATON ROUGE, LA 70816-8251
(225) 248-1771
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
5819RC
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1213659
—
LA
01
—
2035440
PK
—
Enumeration date
05/21/2007
Last updated
06/13/2025
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