# WAL-MART PUERTO RICO INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SAMS PHARMACY 10-6543
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588706212
- **Authorized official:** KIMBERLY CANONIC (SR DIRECTOR)
- **Authorized official phone:** (480) 853-0515

## Contact information

- **Practice address:** PARQUE ESCORIAL CARR 3 BO SAN ANTON, CAROLINA, PR 00987-5162
- **Practice address phone:** (787) 769-2038
- **Practice address fax:** (787) 769-2047
- **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 | — |
| 3336C0003X | Community/Retail Pharmacy | 18-F-2420 | PR | Yes |

## Other

- **Enumeration date:** 02/12/2007
- **Last updated:** 07/17/2026