Wal-Mart Stores Texas LLC
NPI 1104843218 · Community/Retail Pharmacy · Mansfield, TX
Enrolled with Medicare as Dme Supplier - Pharmacy · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1104843218
- Entity type
- Organization
- Primary specialty
- Community/Retail PharmacySuppliers
- Organization subpart
- No
- Authorized official
- Kimberly Canonic, Senior Director, Enrollment(480) 277-6348
Specialties & taxonomies
Suppliers
Suppliers
- Pharmacy333600000X
Suppliers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure28% of score
19 yrs in NPPES registry
- Profile completeness28% of score
100% of core fields populated
- Practice footprint17% of score
1 documented practice location
- Medicare service volume (vs. specialty peers)28% of score
148 Medicare services, 2024 (ranked within specialty)
Medicare volume is ranked against active providers in the same specialty. Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
What this provider does (Medicare)
Based on Medicare fee-for-service claims, 2024; not all care is captured.
| Service (HCPCS) | Medicare services | Typical Medicare-allowed (2024) |
|---|---|---|
| Administration of Influenza Virus VaccineG0008 | 76 | $21 |
| Admn Sarscov2 Vacc 1 Dose90480 | 53 | $11 |
| Administration of Pneumococcal VaccineG0009 | 19 | $21 |
Typical Medicare-allowed amounts for these services range $11–$21 (2024). The Medicare-allowed amount is what Medicare recognizes for a service under fee-for-service — a reference figure for 2024, not a price quote and not what you would be billed. Medicare Part B covers roughly an eighth of all NPIs (65+ skew); services with fewer than 11 beneficiaries are suppressed by CMS. Source: CMS Medicare Physician & Other Practitioners, by Provider & Service.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Walmart Pharmacy 10-0284
Registry dates
- Enumerated
- 2006-07-16
- Last updated
- 2025-05-30
- Certified
- 2025-05-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.