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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Walmart Pharmacy 10-7232
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
108 W PARKERVILLE RD, DESOTO, TX 75115-8074
(469) 643-5017
(469) 643-5014
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
29603
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2148850
PK
—
05
—
470007
—
TX
Enumeration date
10/07/2014
Last updated
06/12/2025
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