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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
WalMart Pharmacy 10-4194
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
4001 HOUSTON HWY, VICTORIA, TX 77901-4990
(361) 827-7275
(361) 827-7276
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28596
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346582467
—
TX
01
—
2140782
PK
—
05
—
470521
—
TX
Enumeration date
03/27/2013
Last updated
06/09/2025
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