# WAL-MART PUERTO RICO INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SAMS PHARMACY 10-4806
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508051608
- **Authorized official:** SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
- **Authorized official phone:** (479) 277-2500

## Contact information

- **Practice address:** CARR. 3 KM. 15.2 BO. CANOVANILLAS, CAROLINA, PR 00987
- **Practice address phone:** (787) 769-1989
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-0445

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 17-F-2543 | PR | Yes |

## Other

- **Enumeration date:** 09/11/2007
- **Last updated:** 02/16/2017