Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Walmart Pharmacy 10-7240
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
8800 LAKEVIEW PKWY, ROWLETT, TX 75088-4498
(972) 202-8504
(972) 202-8500
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
29530
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2148680
PK
—
05
—
470199
—
TX
Enumeration date
11/06/2014
Last updated
06/12/2025
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