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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
WAL-MART PHARMACY 10-0464
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
3829 INTERSTATE HIGHWAY 69 ACCESS RD, CORPUS CHRISTI, TX 78410-4525
(361) 387-4920
(361) 387-6773
Mailing address
1 CUSTOMER DR, MS 0445, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
21846
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2097391
PK
—
05
—
469175
—
TX
Enumeration date
07/16/2006
Last updated
06/23/2026
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