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
PLZ PAIMA REAL PR 3 KM 77.6, HUMACAO, PR 00791-4726
(787) 852-9620
(787) 852-9612
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
19-F-1445
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2086097
PK
—
Enumeration date
07/28/2006
Last updated
06/05/2025
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