Wal-Mart Stores Texas LLC
NPI 1285168039ActiveOrganization· Pharmacy· Prosper, TX
Pharmacy in Prosper, Texas, registered in NPPES in April 2017. The authorized official on file is Kimberly Canonic, Senior Director, Enrollment. Medicare paid $29,844 for services to 136 patients in 2024.
Overview
| NPI | 1285168039 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Apr 19, 2017 |
| Last updated in NPPES | Jun 12, 2025 |
| Certified by provider | Jun 12, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Pharmacy Primary | 333600000X | 31275 | TX |
| Durable Medical Equipment & Medical Supplies | 332B00000X | — | — |
| Pharmacy, Community/Retail Pharmacy | 3336C0003X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 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 | 136 |
|---|---|
| Services billed | 420 across 10 procedure codes |
| Paid by Medicare | $29,844 |
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