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Organization
SAM'S EAST, INC.
Active
Organization
SAM'S EAST, INC.
Active
Parent organization
WAL-MART STORES, INC.
Other names
Sam's Club Pharmacy 10-6582
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAL-MART STORES, INC.
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
14 BLUFFTON ROAD, BLUFFTON, SC 29910-0000
(843) 837-1862
(843) 837-1113
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
717034
—
SC
Enumeration date
10/14/2016
Last updated
06/17/2025
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