Organization
WAL-MART STORES TEXAS LLC
Active
Other names
WALMART PHARMACY 10-0426
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
4691 STATE HIGHWAY 121, THE COLONY, TX 75056-4010
(972) 625-3784
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
21694
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
066458302
—
TX
01
—
2105615
PK
—
05
—
470054
—
TX
Enumeration date
07/16/2006
Last updated
06/03/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us