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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Walmart Pharmacy 10-5224
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
4226 DE ZAVALA RD, SAN ANTONIO, TX 78249-3082
(210) 774-2736
(210) 774-2735
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8705
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
29277
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083014880
—
TX
01
—
2147626
PK
—
05
—
469291
—
TX
Enumeration date
08/28/2014
Last updated
06/06/2025
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