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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
WalMart Pharmacy 10-4182
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
3312 PRESTON RD, PLANO, TX 75093-7404
(469) 304-3124
(972) 519-1927
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72712-6209
(479) 204-8705
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
28560
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437594926
—
TX
01
—
2140501
PK
—
05
—
469744
—
TX
Enumeration date
05/09/2013
Last updated
06/06/2025
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