Wal-Mart Stores Texas LLC
Organization Active NPI Community/Retail Pharmacy · McAllen, TX
NPI 1235523739 · NPPES record last updated Jun 9, 2025
Key facts
- NPI
- 1235523739
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 29783 (TX)
- Legal business name
- WAL-MART STORES TEXAS LLC
- Practice address
- 5700 N 23Rd St
McAllen, TX 78504-3907 - Phone
- (956) 800-6853
- Fax
- (956) 800-6854
- NPI assigned
- Mar 23, 2015
- Organization subpart
- No
Authorized official
- Name
- Kimberly Canonic
- Title
- Senior Director, Enrollment
- Phone
- (480) 277-6348
Corporate family (same tax ID) 24
Member of 1
Practitioners 2
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2107392 | Walmart Pharmacy 10-6786 | Certificate of waiver | Jan 11, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Walmart Pharmacy 10-6786 |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Ostomy Supplies|Enteral Nutrients|Surgical Dressings | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130611000245 | TX | Part B Supplier - Mass Immunization (Roster Biller Only) | 7719199165 | This NPI is an additional NPI on the enrollment |
| O20150803000946 | TX | DME Supplier - Pharmacy | 7719199165 | Practice locations: McAllen, TX |
National Provider Directory
- Tax ID family
- Wal-Mart Stores Teas LLC
Locations
5700 N 23rd St
McAllen, TX 78504
Phone (956) 800-6823
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | 29783 | TX | Yes |
Addresses
Primary practice location
5700 N 23Rd St
McAllen, TX 78504-3907
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 277-1242
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2151038 | Other | PK | |
| 469854 | Medicaid | TX |
Other names
- Walmart Pharmacy 10-6786
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Other providers in McAllen, TX
- Christine Tiffany Vu
- Vuela Therapeutic Specialists, PLLC
- W.I.S.H. 'Weight Initiative to Sustain Health'
- Zachary Wade
- Nurul Abul Wahid
- Wal-Mart Stores Texas LLC
- Wal-Mart Stores Texas LLC
- Wal-Mart Stores Texas LLC
- Wal-Mart Stores Texas, LP
- Wal-Mart Stores Texas, LP
All providers in McAllen, TX · Community/Retail Pharmacy in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 9, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.