Provider Demographics
NPI:1154455145
Name:WAL-MART LOUISIANA, LLC
Entity Type:Organization
Organization Name:WAL-MART LOUISIANA, LLC
Other - Org Name:WAL-MART PHARMACY 10-5022
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY LICENSING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-237-6874
Mailing Address - Street 1:702 SW 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72716-0230
Mailing Address - Country:US
Mailing Address - Phone:479-273-6874
Mailing Address - Fax:
Practice Address - Street 1:1901 TCHOUPITOULAS STREET
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130
Practice Address - Country:US
Practice Address - Phone:504-522-6959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy