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Organization
WAL-MART PUERTO RICO INC
Active
Organization
WAL-MART PUERTO RICO INC
Active
Other names
WALMART PHARMACY 10-2067
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
975 AVE HOSTOS STE 2100, MAYAGUEZ MALL CARR 2, MAYAGUEZ, PR 00680-1252
(787) 265-1090
(479) 277-4331
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-2163
PR
Other
Enumeration date
07/26/2006
Last updated
07/17/2026
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