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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
WalMart Pharmacy 10-4131
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
9427 CULEBRA RD, SAN ANTONIO, TX 78251-3506
(210) 526-6007
(210) 680-0543
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28784
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972942993
—
TX
01
—
2141275
PK
—
05
—
469975
—
TX
Enumeration date
06/24/2013
Last updated
06/06/2025
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