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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
WALMART PHARMACY 10-2625
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1025 W TRINITY MILLS RD, CARROLLTON, TX 75006-1375
(800) 273-3455
(800) 406-8976
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
03779/7.1
MS
3336C0003X
Community/Retail Pharmacy
054.013662
IL
3336C0003X
Community/Retail Pharmacy
126
NE
3336C0003X
Community/Retail Pharmacy
2002012999
MO
3336C0003X
Community/Retail Pharmacy
22-01391
KS
3336C0003X
Community/Retail Pharmacy
261465
MN
3336C0003X
Community/Retail Pharmacy
28RO00006000
NJ
3336C0003X
Community/Retail Pharmacy
3242
TN
3336C0003X
Community/Retail Pharmacy
400-0003
SD
3336C0003X
Community/Retail Pharmacy
4785OS
LA
3336C0003X
Community/Retail Pharmacy
64000067A
IN
3336C0003X
Community/Retail Pharmacy
99-200
OK
3336C0003X
Community/Retail Pharmacy
Primary
OS01265
AR
3336C0003X
Community/Retail Pharmacy
PHA-MOP-LIC-37
MT
3336C0003X
Community/Retail Pharmacy
TX377
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0162973
—
NJ
05
—
0162973
—
TX
05
—
100243640D
—
TX
05
—
1020965500001
—
PA
05
—
1215956222
—
MT
05
—
1215956222
—
TX
05
—
1215956222
—
VA
05
—
166999407
—
AR
05
—
200538680A
—
TX
01
—
2095511
PK
—
05
—
3810011244
—
WV
05
—
4582517
—
TN
05
—
470020
—
TX
05
—
6031421
—
WA
05
—
613556
—
TX
05
—
7100037990
—
KY
05
—
7T2283
—
SC
05
—
PH386
—
TX
Enumeration date
07/19/2006
Last updated
06/12/2025
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