NPIMap

Organization Active NPI

Wal-Mart Puerto Rico Inc

  • Community/Retail Pharmacy
  • Hatillo, PR
National Provider Identifier
1396768461
Registry record updated Jul 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
19-F-2215 Issued in PR
Legal business name
WAL-MART PUERTO RICO INC
Practice address
Carr 2 KM 84.2
Hatillo, PR 00659-0000
Phone
(787) 544-7265
Fax
(787) 820-5322
NPI assigned
Jul 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2026

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

Authorized official

Name
Kimberly Canonic
Title
Sr Director
Phone
(480) 853-0515

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 19-F-2215 PR Primary

Addresses

Primary practice location

Carr 2 KM 84.2
Hatillo, PR 00659-0000

Mailing address

1 Customer Dr
Ms 0445
Bentonville, AR 72716-0445

Other identifiers 1

IdentifierTypeStateIssuer
2087309OtherPK

Other names 1

  • Sam's Pharmacy 10-6270 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930009999 PR DME Supplier - PharmacyDME Supplier - Optician 1850508573 Practice locations: Hatillo, PR
O20140130001758 PR Part B Supplier - Mass Immunization (Roster Biller Only) 1850508573 29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Juan, PR; Toa Baja, PR; Santa Isabel, PR; Ponce, PR; Mayaguez, PR; Manati, PR; Isabela, PR; Humacao, PR…

Other NPIs with the same Medicare PAC ID 19

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 19

Other NPIs on the same Medicare enrollment 29

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 29

National Provider Directory

National Provider Directory
Tax ID family
Ability Network66 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Member of 2

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

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784246400000",
    "number": "1396768461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CUSTOMER DR",
            "address_2": "MS 0445",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CARR 2 KM 84.2",
            "city": "HATILLO",
            "state": "PR",
            "postal_code": "006590000",
            "telephone_number": "787-544-7265",
            "fax_number": "787-820-5322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART PUERTO RICO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-26",
        "last_updated": "2026-07-17",
        "certification_date": "2026-07-17",
        "status": "A",
        "authorized_official_last_name": "CANONIC",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "SR DIRECTOR",
        "authorized_official_telephone_number": "480-853-0515"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PR",
            "license": "19-F-2215",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2087309",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sam's Pharmacy 10-6270",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hatillo, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.