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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
WALMART PHARMACY 10-3870
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
5401 PARK SPRINGS BLVD, ARLINGTON, TX 76017-3418
(817) 466-0677
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
25833
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376722835
—
TX
01
—
2100516
PK
—
05
—
469513
—
TX
Enumeration date
10/31/2007
Last updated
07/08/2025
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