NPIMap

Wal-Mart Stores Texas LLC

Organization Active NPI Community/Retail Pharmacy · Converse, TX

NPI 1245688449 · NPPES record last updated Jun 6, 2025

Key facts

NPI
1245688449
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
30803 (TX)
Legal business name
WAL-MART STORES TEXAS LLC
Practice address
10781 Toepperwein Rd
Converse, TX 78109-2561
Phone
(210) 672-6812
Fax
(210) 672-6811
NPI assigned
May 27, 2016
Organization subpart
No

Authorized official

Name
Kimberly Canonic
Title
Senior Director, Enrollment
Phone
(480) 277-6348

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2118802Walmart Pharmacy 10-4056
10781 Toepperwein Road, Converse, TX 78109		Certificate of waiverSep 13, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Walmart Pharmacy 10-4056
10781 Toepperwein Rd, Converse, TX 78109-2561 · (210) 672-6812		 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
Participating since Nov 29, 2001

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in TX

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20130611000245 TX Part B Supplier - Mass Immunization (Roster Biller Only) 7719199165 This NPI is an additional NPI on the enrollment
O20160907001626 TX DME Supplier - Pharmacy 7719199165 Practice locations: Converse, TX

National Provider Directory

Tax ID family
Wal-Mart Stores Teas LLC (879 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 30803 TX Yes

Addresses

Primary practice location

10781 Toepperwein Rd
Converse, TX 78109-2561

Mailing address

702 SW 8TH St
Mailstop 0445
Bentonville, AR 72716-0445
Phone (479) 277-1242

Other identifiers

IdentifierTypeStateIssuer
2160930OtherPK
470931MedicaidTX

Other names

  • Walmart Pharmacy 10-4056 Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Other providers in Converse, TX

All providers in Converse, TX · Community/Retail Pharmacy in Texas

Sources for this page

Verify at the official NPI Registry.