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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Walmart Pharmacy 10-0999
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
7239 SW LOOP 410, SAN ANTONIO, TX 78242-2049
(210) 247-5912
(210) 247-5906
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72712-6209
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28917
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2142708
PK
—
05
—
470176
—
TX
Enumeration date
10/11/2013
Last updated
06/05/2025
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