# WAL-MART PUERTO RICO INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Walmart Pharmacy 10-1822
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326065574
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 853-0515

## Contact information

- **Practice address:** 150 CARR 940 STE 180, FAJARDO, PR 00738-3653
- **Practice address phone:** (787) 801-0500
- **Practice address fax:** (787) 801-0501
- **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 | 19-F-1721 | PR | Yes |

## Other

- **Enumeration date:** 07/16/2006
- **Last updated:** 07/17/2026