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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Walmart Pharmacy 10-5823
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
6185 RETAIL RD STE 200, DALLAS, TX 75231-7807
(972) 656-2215
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
27580
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2130772
PK
—
05
—
469862
—
TX
Enumeration date
06/16/2011
Last updated
06/18/2025
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