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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy

General Provider Information

NPI Number	:	1396603916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAL-MART STORES TEXAS, LLC

Provider Business Mailing Address
First Line	:	1 CUSTOMER DR
Second Line	:	MAIL STOP 0445
City	:	BENTONVILLE
State	:	AR
Zip	:	72716-0445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 ICY TRL
Second Line	:
City	:	CELINA
State	:	TX
Zip	:	75009-5780
Country	:	US
Telephone Number	:	972-382-0133
Fax Number	:	972-382-0135

Authorized Official
Title or Position	:	SENIOR DIRECTOR
Name	:	KIMBERLY CANONIC
Credential	:
Telephone Number	:	480-853-0515

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/13/2026

Similar Medicare Providers

1134052871 — MONOCLE EYECARE
Practice Location Address:

400 ICY TRL
CELINA, TX
75009-5780

Practice Phone: 682-287-7073
Practice Fax:

1629936240 — WAL-MART STORES TEXAS, LLC
Practice Location Address:

400 ICY TRL
CELINA, TX
75009-5780

Practice Phone: 972-382-0148
Practice Fax:

1699607168 — KRISHNA PABBA MD PLLC
Practice Location Address:

1308 PEAKS VIEW LN STE 110
CELINA, TX
75009-5783

Practice Phone: 817-874-1754
Practice Fax:

1376472464 — COSTCO WHOLESALE CORPORATION
Practice Location Address:

3445 S PRESTON RD
CELINA, TX
75009-6928

Practice Phone: 972-346-6712
Practice Fax: 972-382-5954

1356273155 — SAIMIK LLC
Practice Location Address:

3308 MACAW RD
CELINA, TX
75009-2000

Practice Phone: 214-437-0421
Practice Fax:

1720911969 — SURAKSHAYA PAUDEL
Practice Location Address:

2502 WAR ADMIRAL ST
CELINA, TX
75009-1725

Practice Phone: 531-218-7219
Practice Fax:

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

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.