Wal-Mart Stores Texas LLC
NPI 1285006544ActiveOrganization· Pharmacy· Tyler, TX
Pharmacy in Tyler, Texas, registered in NPPES in October 2015. The authorized official on file is Kimberly Canonic, Senior Director, Enrollment. Medicare paid $26,685 for services to 96 patients in 2024.
Overview
| NPI | 1285006544 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Oct 27, 2015 |
| Last updated in NPPES | Jun 12, 2025 |
| Certified by provider | Jun 12, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Pharmacy Primary | 333600000X | 30184 | TX |
| Durable Medical Equipment & Medical Supplies | 332B00000X | — | — |
| Pharmacy, Community/Retail Pharmacy | 3336C0003X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled DME Supplier - Pharmacy (TX) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 96 |
|---|---|
| Services billed | 342 across 10 procedure codes |
| Paid by Medicare | $26,685 |
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