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General NPI Number Information
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NPI Number | 1295958213
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Entity Type | Organization
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Legal Business Name | WAL-MART PUERTO RICO
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | CARR ESTATAL #153 KM 7.2
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City | SANTA ISABEL
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State | PR
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Zip | 00757
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Country | US
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Telephone | 787-971-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 702 SW 8TH ST
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City | BENTONVILLE
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State | AR
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Zip | 72716-0230
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Country | US
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Telephone | 479-273-6874
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Fax |
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Authorized Official
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Title or Position | PHARMACY LICENSING SUPERVISOR
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Name | KARI BAKER
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Credential |
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Telephone | 479-273-6874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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