Organization
WAL-MART PUERTO RICO INC
Active
Other names
Sam's Pharmacy 10-4866
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
PR-2 KM 2.2 KENNEDY AVE, MARGINAL JOHN F KENNEDY, SAN JUAN, PR 00920-1715
(787) 522-3601
(787) 522-3609
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
19-F-2003
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2132770
PK
—
Enumeration date
11/18/2011
Last updated
07/17/2026
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