# WAL-MART STORES TEXAS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Walmart Pharmacy 10-6963
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134667645
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 853-0515

## Contact information

- **Practice address:** 521 S. CENTRAL EXPRESS WAY, ANNA, TX 75409
- **Practice address phone:** (972) 924-3368
- **Practice address fax:** (972) 924-3370
- **Mailing address:** 702 SW 8TH ST, MS 0445, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (479) 204-1258
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | — | — |
| 333600000X | Pharmacy | — | — | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | — | — |

## Other

- **Enumeration date:** 02/03/2017
- **Last updated:** 06/12/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2168149 | PK | — |
| 05 | — | 471173 | — | TX |