Organization
WAL-MART PUERTO RICO INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
AVE LOS VETERANOS KM 134.7, GUAYAMA, PR 00784
(787) 866-9409
(787) 866-2075
Mailing address
1 CUSTOMER DR # MS 0445, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
19-F-2292
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2086532
PK
—
Enumeration date
07/26/2006
Last updated
01/28/2026
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