Provider Demographics
NPI:1588948335
Name:WALMART PR INC.
Entity type:Organization
Organization Name:WALMART PR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RETAIL BUSINESS STRATEGIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PABON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-653-8031
Mailing Address - Street 1:CARR # 1
Mailing Address - Street 2:PMB 725 BOX 4960
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:787-653-8031
Mailing Address - Fax:187-798-1206
Practice Address - Street 1:CARR # 1 BO. RIO CANAS
Practice Address - Street 2:PMB 725 BOX 4960
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726
Practice Address - Country:US
Practice Address - Phone:787-653-8031
Practice Address - Fax:187-798-1206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier