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Organization
WAL-MART PUERTO RICO INC
Active
Organization
WAL-MART PUERTO RICO INC
Active
Other names
Walmart Pharmacy 10-1822
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
150 CARR 940 STE 180, FAJARDO, PR 00738-3653
(787) 801-0500
(787) 801-0501
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
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
19-F-1721
PR
Other
Enumeration date
07/16/2006
Last updated
07/17/2026
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