DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: WAL-MART STORES EAST, LP

MEDICARE: WAL-MART STORES EAST, LP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail PharmacyPHY.007036-RCLA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12149194OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962805671
Entity Type Code : Organization
Provider Name (Legal Business Name) : WAL-MART STORES EAST, LP
Provider Business Mailing Address
First Line : 702 SW 8TH ST
Second Line :
City : BENTONVILLE
State : AR
Zip : 72716-0445
Country : US
Telephone Number : 479-204-8550
Fax Number : 479-277-4331
Provider Business Practice Location Address
First Line : 2400 CYPRESS ST
Second Line :
City : WEST MONROE
State : LA
Zip : 71291-4555
Country : US
Telephone Number : 318-267-3001
Fax Number : 318-267-3002
Authorized Official
Title or Position : SENIOR DIRECTOR, ENROLLMENT
Name : KIMBERLY CANONIC
Credential :
Telephone Number : 480-277-6348
Provider Enumeration Date : 10/08/2014
Last Update Date : 06/10/2025

Similar Medicare Providers

1497832083 — DR. LYSA CHARLES MD
Practice Location Address:
2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908
Practice Phone: 301-816-6660
Practice Fax: 301-816-6308
1720420524 — VERLENCIA JORDAN TARVIN PHARM. D.
Practice Location Address:
2400 CYPRESS ST
WEST MONROE, LA
71291-4555
Practice Phone: 318-267-3001
Practice Fax:
1063913960 — MARY MARGARET WHITE DOWNHOUR
Practice Location Address:
2400 CYPRESS ST
WEST MONROE, LA
71291-4555
Practice Phone: 318-267-3001
Practice Fax:
1730789868 — ANGELA NICOLE HOTARD
Practice Location Address:
2400 CYPRESS ST
WEST MONROE, LA
71291-4555
Practice Phone: 318-267-3001
Practice Fax:
1407438195 — LISA ENGLISH
Practice Location Address:
2400 CYPRESS ST
WEST MONROE, LA
71291-4555
Practice Phone: 318-267-3001
Practice Fax:
1710569496 — FARREN LOWE
Practice Location Address:
2400 CYPRESS ST
WEST MONROE, LA
71291-4555
Practice Phone: 318-267-3001
Practice Fax:

Directions to “WAL-MART STORES EAST, LP ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.