Organization
WAL-MART STORES EAST , LP
Active
Other names
Walmart Pharmacy 10-3746
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
412 BERT KOUNS INDUSTRIAL LOOP, SHREVEPORT, LA 71106-8127
(318) 840-0477
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 204-8550
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
PHY.007233-RC
LA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2155220
PK
—
Enumeration date
10/26/2015
Last updated
06/10/2025
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