National Provider Identifier Database

WAL MART STORES EAST LP
Pharmacy

A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.


Contact Information

WAL-MART STORES EAST , LP
4701 NORTHPORT BLVD
SHREVEPORT, LA71107
Phone: 318-929-3071
Fax:
Website:
Specialty Taxonomy Code
* Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X
Durable Medical Equipment & Medical Supplies 332B00000X

* Indicates primary specialty

NPI Profile & details for WAL-MART STORES EAST , LP

NPI Number 1396117735
Legal business name
LBN
WAL-MART STORES EAST , LP
Authorized official KIMBERLY CANONIC - (SENIOR DIRECTOR, ENROLLMENT)
Entity Organization
Organization subpart No
Enumeration date 10/26/2015
Last updated 06/10/2025 - About 12 months ago
Sole proprietor1 Not specified
Identifiers
  • LA License #: PHY.007230-RC
  • LA Medicaid: 2204173
  • Other: 2155385 PK

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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