Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Walmart Pharmacy 10-4102
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1151 US HIGHWAY 90 E, CASTROVILLE, TX 78009-5306
(830) 538-6388
(830) 538-6393
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2167356
PK
—
05
—
471163
—
TX
Enumeration date
11/28/2016
Last updated
06/06/2025
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