Wal-Mart Puerto Rico Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

07F2313 Issued in PR

Legal business name

WAL-MART PUERTO RICO INC

Doing business as

Wal-Mart Pharmacy

Practice address

Carr 194 KM 2 0
Fajardo, PR 00738

Phone

(787) 863-7404

NPI assigned

Jul 26, 2006

Last updated

Dec 14, 2012By the provider in NPPES

Organization subpart

Yes

Parent organization

WAL-MART STORES INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Laura Levine

Title

MGR of Government Contracting

Phone

(479) 204-8550

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• WAL-MART PHARMACY Doing business as

Part of

Walmart Pharmacy 10-206

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Sams West Inc

  dba Sams Pharmacy 10-6254

  • Community/Retail Pharmacy
  • Maple Grove, MN
  • NPI 1184641581

  Member Of

  NPD member
• Walmart Inc.

  dba Walmart Pharmacy 10-1588

  • Community/Retail Pharmacy
  • Victorville, CA
  • NPI 1043237456

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355443200000",
    "number": "1033132113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SW 8TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CARR 194 KM 2 0",
            "city": "FAJARDO",
            "state": "PR",
            "postal_code": "00738",
            "telephone_number": "787-863-7404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART PUERTO RICO INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAL-MART STORES INC",
        "enumeration_date": "2006-07-26",
        "last_updated": "2012-12-14",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "MGR OF GOVERNMENT CONTRACTING",
        "authorized_official_telephone_number": "479-204-8550"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PR",
            "license": "07F2313",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07F2313",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4024989",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WAL-MART PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Luce Villafane Carmona
• Jesus Manuel Villafane, M.D.
• Cynthia E Villalobos Ortiz, O.D.
• Richard Anthony Vito, M.D., FACEP
• Francisco J Vizcarrondo, MD
• Wal-Mart Puerto Rico Inc (Walmart Vision Center 30-1822)
• Wal-Mart Puerto Rico Inc (Walmart Pharmacy 10-1822)
• Wal-Mart Puerto Rico Inc (Vision Center 30-1822)
• Walgreen Co (Walgreens #12012)
• Walgreen Co (Walgreens #00251)

• Community/Retail Pharmacy in Fajardo, PR
• Providers in Fajardo, PR by specialty
• Community/Retail Pharmacy in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.