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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Walmart Pharmacy 10-5707
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
11700 US HIGHWAY 380, CROSSROADS, TX 76227-8200
(940) 488-7011
(940) 488-7012
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-0709
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28581
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2141147
PK
—
05
—
469956
—
TX
Enumeration date
06/26/2013
Last updated
07/07/2025
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