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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Walmart Pharmacy 10-3057
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
12550 LESLIE RD, HELOTES, TX 78023-4740
(210) 507-4982
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-0709
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
28382
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780923904
—
TX
01
—
2138885
PK
—
05
—
469619
—
TX
Enumeration date
02/07/2013
Last updated
06/05/2025
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