Organization
WAL-MART PUERTO RICO INC
Active
Other names
Wal-Mart Pharmacy 10-2346
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
CARR 2 SECTOR LA VIRGENCITA INTER, CARR 165 MEDIA LUNA WARD, TOA BAJA, PR 00949
(787) 641-5650
Mailing address
1 CUSTOMER DR, MS 0445, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
18-F-3066
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2137078
PK
—
Enumeration date
09/18/2012
Last updated
07/17/2026
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