Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Walmart Pharmacy 10-6579
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
20310 US 59, NEW CANEY, TX 77357
(281) 306-7099
(281) 306-7098
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-1258
(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
—
2169052
PK
—
Enumeration date
04/19/2017
Last updated
06/12/2025
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