Organization
WAL-MART STORES TEXAS LLC
Active
Other names
WALMART PHARMACY 10-0407
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1400 LOWES BLVD, KILLEEN, TX 76542-5201
(254) 526-4433
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
21802
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2103888
PK
—
05
—
468799
—
TX
Enumeration date
07/16/2006
Last updated
06/02/2025
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