Organization
WAL-MART STORES EAST , LP
Active
Other names
Walmart Pharmacy 10-5102
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
99 WESTBANK EXPY, GRETNA, LA 70053-3663
(504) 249-7147
(504) 249-7142
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY.007224-RC
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2154940
PK
—
05
—
2204360
—
LA
Enumeration date
09/24/2015
Last updated
06/10/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us