Organization
WAL-MART PUERTO RICO INC
Active
Other names
WalMart Pharmacy 10-5803
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 AVE R H TODD ESQ, CALLE CORCHADO SANTURCE, SAN JUAN, PR 00907
(787) 641-5606
(787) 945-5016
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-0709
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
19-F-3103
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2138940
PK
—
Enumeration date
02/13/2013
Last updated
06/06/2025
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