Healthcare Provider Details

I. General information

NPI: 1427314129
Provider Name (Legal Business Name): WALMART
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 CARR #2
BARCELONETA PR
00936
US

IV. Provider business mailing address

1145 CARR #2
BARCELONETA PR
00936
US

V. Phone/Fax

Practice location:
  • Phone: 787-522-3604
  • Fax: 787-522-3611
Mailing address:
  • Phone: 787-522-3604
  • Fax: 787-522-3611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. KYLMARIE SERRANO
Title or Position: HEALTH & WELLNESS REGIONAL DIRECTOR
Credential:
Phone: 787-653-7777