# WAL-MART PUERTO RICO INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WALMART PHARMACY 10-3693
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174666556
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 277-6348

## Contact information

- **Practice address:** CARR ESTATAL 153 KM 7.2, SANTA ISABEL, PR 00757-4005
- **Practice address phone:** (787) 971-1010
- **Practice address fax:** (787) 845-0020
- **Mailing address:** 1 CUSTOMER DR, MS 0445, BENTONVILLE, AR 72716-0445

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 18-F-2415 | PR | Yes |

## Other

- **Enumeration date:** 02/15/2007
- **Last updated:** 07/17/2026