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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Walmart Pharmacy 10-4371
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3520 RICHMOND RD, TEXARKANA, TX 75503-0705
(903) 716-7110
(903) 716-7111
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
29761
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208760407
—
AR
01
—
2150355
PK
—
05
—
469709
—
TX
Enumeration date
02/16/2015
Last updated
06/10/2025
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