Wal-Mart Stores Texas LLC

NPI #1245777895 in Tyler, Texas

Provider Information

NPI Number
1245777895
Entity Type
Organization
Organization Name
Wal-Mart Stores Texas LLC
Primary Specialty
Pharmacy
Enumeration Date
Jan 20, 2017
Last Updated
Jun 12, 2025

Practice Location

Address
450 S SOUTHEAST LOOP 323
City
Tyler
State
Texas
ZIP Code
75702-8646
Phone
(903) 405-6389

Authorized Official

Name
KIMBERLY CANONIC
Title
SENIOR DIRECTOR, ENROLLMENT
Phone
(480) 853-0515

Specialties & Taxonomy Codes

Specialty
Durable Medical Equipment & Medical Supplies
Pharmacy - Community/Retail PharmacyCommunity/Retail Pharmacy
Pharmacy

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