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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Walmart Pharmacy 10-4114
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
3812 GILMER RD, LONGVIEW, TX 75604-1173
(903) 475-0452
(903) 475-0478
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
29207
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821404534
—
TX
01
—
2146775
PK
—
05
—
470363
—
TX
Enumeration date
07/02/2014
Last updated
06/09/2025
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