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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Wal-Mart Pharmacy 10-3170
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1320 HWY 290 E, ELGIN, TX 78621-2128
(512) 285-3649
(512) 285-3689
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-0709
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28938
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205257110
—
TX
01
—
2143533
PK
—
05
—
469565
—
TX
Enumeration date
12/18/2013
Last updated
06/05/2025
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