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Organization
WAL-MART STORES TEXAS, LLC
Active
Organization
WAL-MART STORES TEXAS, LLC
Active
Other names
Walmart Pharmacy 10-3135
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
717 W BERRY ST, FORT WORTH, TX 76110-3530
(817) 840-0263
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28361
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275872756
—
TX
01
—
2138806
PK
—
05
—
468822
—
TX
Enumeration date
02/04/2013
Last updated
06/06/2025
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