Wal-Mart Stores East , LP
Organization Active NPI Community/Retail Pharmacy · Meraux, LA
NPI 1104299650 · NPPES record last updated Jun 10, 2025
Key facts
- NPI
- 1104299650
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHY.007250-RC (LA)
- Legal business name
- WAL-MART STORES EAST , LP
- Practice address
- 2550 Archbishop Hannan Blvd
Meraux, LA 70075-2637 - Phone
- (504) 249-7756
- Fax
- (504) 249-7755
- NPI assigned
- Nov 5, 2015
- Organization subpart
- No
Authorized official
- Name
- Kimberly Canonic
- Title
- Senior Director, Enrollment
- Phone
- (480) 277-6348
Corporate family (same tax ID) 24
Member of 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140613001865 | LA | Part B Supplier - Mass Immunization (Roster Biller Only) | 6204749997 | This NPI is an additional NPI on the enrollment |
| O20160226000847 | LA | DME Supplier - Pharmacy | 6204749997 | Practice locations: Meraux, LA |
National Provider Directory
- Tax ID family
- Ability Network
Locations
2550 Archbishop Hannan Blvd
Meraux, LA 70075
Phone (504) 249-7756
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHY.007250-RC | LA | Yes |
Addresses
Primary practice location
2550 Archbishop Hannan Blvd
Meraux, LA 70075-2637
Mailing address
702 SW 8TH St
Mailstop 0445
Bentonville, AR 72716-0445
Phone (479) 204-1258
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2155607 | Other | PK |
Other names
- Walmart Pharmacy 10-5081
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Other providers in Meraux, LA
- Jared Laine Schwab
- Sincere Rehabilitation
- Sincere Rehabilitation
- Kerrell Patrick Sweeney
- Craig Taffaro Jr.
- Walgreen Co.
All providers in Meraux, LA · Community/Retail Pharmacy in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.