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Wal-Mart Stores Texas LLC

Community/Retail Pharmacy in Tyler, TX · enumerated 2013 · authorized official Kimberly Canonic, Senior Director, Enrollment.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1386088078

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Registry record

Entity type Organization (Type 2)
Legal business name Wal-Mart Stores Texas LLC
Other name <Unavail>
Practice address 1900 E Se Loop 323, Tyler, TX, 75701
Phone (903) 508-6127
Fax (903) 508-6128
Enumeration date Apr 24, 2013
Last updated in NPPES Jun 9, 2025

Taxonomy & classification

332B00000X Durable Medical Equipment & Medical Supplies Suppliers Secondary
3336C0003X Community/Retail Pharmacy Suppliers · License 28556 (TX) Primary

Authorized official

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

Other identifiers

Identifier Type State Issuer
2141005 Other - PK
470189 Medicaid TX -
1386088078 Medicaid TX -

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

What is the NPI number for Wal-Mart Stores Texas LLC?
The NPI for Wal-Mart Stores Texas LLC is 1386088078, a Type 2 (organization) record in the CMS NPPES registry.
Who is the authorized official for Wal-Mart Stores Texas LLC?
NPPES lists Kimberly Canonic (Senior Director, Enrollment) as the authorized official for this organization.

Providers at this address

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2025-06-09.