Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-6583
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2011 RYAN ST, LAKE CHARLES, LA 70601-7313
(337) 508-3867
(337) 508-3868
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.007231-RC
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2154956
PK
—
05
—
2204084
—
LA
Enumeration date
10/08/2015
Last updated
06/10/2025
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