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
CARRETERA ESTATAL 2, 2188 AVE EDUARDO RUBERTE, PONCE, PR 00728-2777
(787) 843-4835
(787) 841-4185
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
19-F-2746
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2120478
PK
—
Enumeration date
06/03/2009
Last updated
06/05/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us