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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Walmart Pharmacy 10-5672
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2662 W LUCAS RD, LUCAS, TX 75002-7513
(469) 675-8110
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-0709
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
28362
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114263126
—
TX
01
—
2138360
PK
—
05
—
469961
—
TX
Enumeration date
12/19/2012
Last updated
06/05/2025
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