Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Walmart Pharmacy 10-4105
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
101 E REDD RD, EL PASO, TX 79932-1981
(915) 206-6140
(915) 206-6141
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
29158
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003226093
—
TX
01
—
2146080
PK
—
05
—
468586
—
TX
Enumeration date
04/30/2014
Last updated
06/09/2025
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