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Organization
WAL-MART PUERTO RICO INC
Active
Organization
WAL-MART PUERTO RICO INC
Active
Other names
Sam's Pharmacy 10-6690
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
CARRETERA ESTATAL 2, 2188 AVE EDUARDO RUBERTE, PONCE, PR 00716-0601
(787) 843-4835
(787) 841-4185
Mailing address
1 CUSTOMER DR, MS 0445, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
19-F-2746
PR
Other
Enumeration date
06/03/2009
Last updated
07/17/2026
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