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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.

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Contact Information

WAL-MART STORES EAST , LP
4701 NORTHPORT BLVD
SHREVEPORT, LA  71107
 Phone: 318-929-3071
 Fax:
 Website:
 

Specialty

 Taxonomy Code Specialty Code Provider Type

Pharmacy

 333600000X 58 Medical Supply Company with Pharmacist
 

Community/Retail Pharmacy

 3336C0003X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

 332B00000X 54 Other Medical Supply Company
Indicates primary specialty

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

NPI Number 1396117735
LBN Legal business name WAL-MART STORES EAST , LP
Authorized official KIMBERLY CANONIC - (SENIOR DIRECTOR, ENROLLMENT)
Entity Organization
Organization subpart 1 No
Enumeration date 10/26/2015
Last updated 06/10/2025 - About 12 months ago
Identifiers
LA License # PHY.007230-RC
LA Medicaid 2204173
Other 2155385 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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