Active NPI
Wal-Mart Puerto Rico Inc
- Community/Retail Pharmacy
- Bayamon, PR
National Provider Identifier
1588705446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 18-F-2409
- Legal business name
- WAL-MART PUERTO RICO INC
- Doing business as
- SAMS PHARMACY 10-6680
- Practice address
- Plaza del Parque 1500
Suite 120 Ave Comerio
Bayamon, PR 00961-4458 - Phone
- (787) 740-0660
- Fax
- (787) 740-0718
- NPI assigned
- Feb 12, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kimberly Canonic
- Title
- Senior Director, Enrollment
- Phone
- (480) 277-6348
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | 18-F-2409 | PR | Primary |
Addresses
Primary practice location
Plaza del Parque 1500
Suite 120 Ave Comerio
Bayamon, PR 00961-4458
Mailing address
1 Customer Dr
Ms 0445
Bentonville, AR 72716-0445
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2087523 | Other | PK |
Other names 1
- SAMS PHARMACY 10-6680
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 on the same Medicare enrollment 29
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryMember of 2
Organizations this organization is a member of, according to the National Provider Directory.
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacy Technician
- Bayamon, PR
- NPI 1639365364
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1784246400000",
"number": "1588705446",
"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": "PLAZA DEL PARQUE 1500",
"address_2": "SUITE 120 AVE COMERIO",
"city": "BAYAMON",
"state": "PR",
"postal_code": "009614458",
"telephone_number": "787-740-0660",
"fax_number": "787-740-0718"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WAL-MART PUERTO RICO INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-12",
"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": "SENIOR DIRECTOR, ENROLLMENT",
"authorized_official_telephone_number": "480-277-6348"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "PR",
"license": "18-F-2409",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2087523",
"state": null
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.667.2",
"affiliationName": "Ability Network",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "100 N 6th St Ste 900A",
"city": "Minneapolis",
"state": "MN",
"country_code": "US",
"postal_code": "554031516",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "SAMS PHARMACY 10-6680",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "SAMS PHARMACY 10-6680",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bayamon, 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.