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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
WALMART PHARMACY 10-3828
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 371-1168
Entity
Organization
Contact information
Practice address
4006 ESTES PKWY, LONGVIEW, TX 75603-1712
(903) 234-2083
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
25439
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2100008
PK
—
05
—
470922
—
TX
Enumeration date
03/15/2007
Last updated
07/08/2025
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