Organization
WAL-MART PUERTO RICO INC
Active
Other names
SAMS PHARMACY 10-6680
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
PLAZA DEL PARQUE 1500, SUITE 120 AVE COMERIO, BAYAMON, PR 00961-4458
(787) 740-0660
(787) 740-0718
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-2409
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2087523
PK
—
Enumeration date
02/12/2007
Last updated
07/17/2026
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