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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Walmart Pharmacy 10-4605
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
5976 OLD JACKSONVILLE HWY, TYLER, TX 75703-0582
(903) 405-6212
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
30183
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2154954
PK
—
05
—
468012
—
TX
Enumeration date
10/13/2015
Last updated
06/10/2025
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