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NPI Code Detail

MEDICARE: WAL-MART STORES TEXAS LLC

MEDICARE: WAL-MART STORES TEXAS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail Pharmacy27288TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22127451OTHERPK

General Provider Information

NPI Number : 1285934901
Entity Type Code : Organization
Provider Name (Legal Business Name) : WAL-MART STORES TEXAS LLC
Provider Business Mailing Address
First Line : 1 CUSTOMER DR # MS 0445
Second Line :
City : BENTONVILLE
State : AR
Zip : 72716-0445
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 730 W EXCHANGE PKWY
Second Line :
City : ALLEN
State : TX
Zip : 75013-7078
Country : US
Telephone Number : 972-649-0364
Fax Number : 972-649-0357
Authorized Official
Title or Position : SR DIRECTOR
Name : KIMBERLY CANONIC
Credential :
Telephone Number : 480-853-0515
Provider Enumeration Date : 10/28/2010
Last Update Date : 05/29/2026

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Directions to “WAL-MART STORES TEXAS LLC ” Practice Location

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