DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
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
2333600000XPharmacy
33336C0003XCommunity/Retail Pharmacy21903TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22097080OTHERPK

General Provider Information

NPI Number : 1396762548
Entity Type Code : Organization
Provider Name (Legal Business Name) : WAL-MART STORES TEXAS LLC
Provider Business Mailing Address
First Line : 702 SW 8TH ST
Second Line :
City : BENTONVILLE
State : AR
Zip : 72716-0445
Country : US
Telephone Number : 479-277-1242
Fax Number : 479-277-4331
Provider Business Practice Location Address
First Line : 12300 LAKE JUNE RD
Second Line :
City : BALCH SPRINGS
State : TX
Zip : 75180-1636
Country : US
Telephone Number : 972-286-0180
Fax Number :
Authorized Official
Title or Position : SENIOR DIRECTOR, ENROLLMENT
Name : KIMBERLY CANONIC
Credential :
Telephone Number : 480-277-6348
Provider Enumeration Date : 07/16/2006
Last Update Date : 06/05/2025

Similar Medicare Providers

1073695110 — WAL-MART STORES TEXAS, LP
Practice Location Address:
12300 LAKE JUNE RD
BALCH SPRINGS, TX
75180-1636
Practice Phone: 972-286-8600
Practice Fax:
1053609255 — TRANG NGUYEN, OD, PA
Practice Location Address:
12300 LAKE JUNE RD
BALCH SPRINGS, TX
75180-1636
Practice Phone: 972-913-0595
Practice Fax:
1164023453 — MATTHEW RICHMOND GEURIN PHARMD
Practice Location Address:
12300 LAKE JUNE RD
BALCH SPRINGS, TX
75180-1636
Practice Phone: 972-286-0180
Practice Fax: 972-286-7770
1366043283 — JANUARY CARRILLO
Practice Location Address:
12300 LAKE JUNE RD
BALCH SPRINGS, TX
75180-1636
Practice Phone: 972-286-0180
Practice Fax:
1245992403 — VICTORIA WHITE
Practice Location Address:
12300 LAKE JUNE RD
BALCH SPRINGS, TX
75180-1636
Practice Phone: 972-281-0180
Practice Fax:
1114915154 — MR. MICHAEL P SAWYER CRNA
Practice Location Address:
1636 HIGDON FERRY RD , MLK BOULEVARD
HOT SPRINGS, AR
71913-6912
Practice Phone: 501-520-5215
Practice Fax: 501-520-3704

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.