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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
WALMART PHARMACY 100181
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MCMULLIN (DIRECTOR, CONTRACTING)
(479) 371-8711
Entity
Organization
Contact information
Practice address
800 JAMES BOWIE DR, NEW BOSTON, TX 75570-2334
(903) 628-6561
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
21676
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2103891
PK
—
05
—
212556407
—
AR
05
—
468492
—
TX
Enumeration date
07/16/2006
Last updated
12/01/2023
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