Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-5773
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1201 PARKVIEW DR, NEW IBERIA, LA 70563-2829
(337) 551-6570
(337) 551-6569
Mailing address
702 SW 8TH ST, MS 0445, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
PHY.007374-RC
LA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2164000
PK
—
05
—
2204785
—
LA
Enumeration date
09/01/2016
Last updated
06/11/2025
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