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Organization
WAL-MART STORES TEXAS, LLC
Active
Organization
WAL-MART STORES TEXAS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
5336 GOLDEN TRIANGLE BLVD, FORT WORTH, TX 76244-4406
(817) 898-6115
(817) 898-6115
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2177280
PK
—
Enumeration date
03/15/2018
Last updated
06/11/2025
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