Organization
WAL-MART STORES EAST, LP
Active
Other names
Walmart Pharmacy 10-3743
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2400 CYPRESS ST, WEST MONROE, LA 71291-4555
(318) 267-3001
(318) 267-3002
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY.007036-RC
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149194
PK
—
05
—
2203525
—
LA
Enumeration date
10/08/2014
Last updated
06/10/2025
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