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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
WALMART PHARMACY 10-4219
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR ENROLLMENT)
(479) 371-1168
Entity
Organization
Contact information
Practice address
690 OLD SAN ANTONIO RD, BUDA, TX 78610-2108
(512) 312-2256
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
25079
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2099371
PK
—
05
—
469713
—
TX
Enumeration date
08/27/2006
Last updated
07/09/2025
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