Organization
WAL-MART PUERTO RICO INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
PLAZA DEL MAR SHOPPING CENTER, CARR 2 KM 84.7 BO CARRAZALES, HATILLO, PR 00659-2701
(787) 817-1070
(787) 817-1340
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-3323
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2086542
PK
—
Enumeration date
07/26/2006
Last updated
06/16/2025
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