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Organization

WAL-MART STORES EAST LP

Active
Other names
WAL-MART PHARMACY
Organization subpart
No

Provider details

NPI number
Authorized official
DIANNA PAINTER (NEW STORE SYS ENROLLMENT)
(479) 277-1238
Entity
Organization

Contact information

Practice address
906 W MAIN ST, HOMER, LA 71040-3328
(318) 927-9055
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209

Taxonomy

Speciality
Code
Description
License number
State
333600000X
Pharmacy
4777RC
LA
3336C0003X
Community/Retail Pharmacy
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1270377
LA
01
1924237
OTHER ID NUMBER-COMMERCIAL NUMBER
Enumeration date
07/16/2006
Last updated
09/11/2025
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