Organization
WAL-MART PUERTO RICO INC
Active
Other names
WALMART PHARMACY 10-2085
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
3535 AVE MILITAR STE 193, ISABELA, PR 00662-4046
(787) 830-3004
(787) 830-3035
Mailing address
702 SW 8TH ST., BENTONVILLE, AR 72716-6209
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
19-F-1992
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2087092
PK
—
Enumeration date
07/26/2006
Last updated
06/04/2025
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