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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Walmart Pharmacy 10-2397
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2951 MATLOCK RD, MANSFIELD, TX 76063-5020
(817) 453-5635
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
21616
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2094950
PK
—
05
—
33293800
—
TX
05
—
468823
—
TX
Enumeration date
07/19/2006
Last updated
05/30/2025
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