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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Walmart Pharmacy 10-4193
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1900 E SE LOOP 323, TYLER, TX 75701-8337
(903) 508-6127
(903) 508-6128
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 204-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28556
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386088078
—
TX
01
—
2141005
PK
—
05
—
470189
—
TX
Enumeration date
04/24/2013
Last updated
06/09/2025
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