Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Walmart Pharmacy 10-7311
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (DIRECTOR)
(480) 853-0515
Entity
Organization
Contact information
Practice address
5154 KNICKERBOCKER RD, SAN ANGELO, TX 76904-7714
(325) 276-6620
(325) 276-6619
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
30612
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2158818
PK
—
05
—
470388
—
TX
Enumeration date
02/29/2016
Last updated
06/12/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up