Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Walmart Pharmacy 10-5700
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2151 FRANKSTON HWY, TYLER, TX 75701-3808
(903) 405-6199
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-6209
(479) 204-8550
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
30184
TX
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2155382
PK
—
05
—
468008
—
TX
Enumeration date
10/27/2015
Last updated
06/12/2025
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