Organization
SAMS EAST INC
Active
Organization
SAMS EAST INC
Active
Parent organization
WAL-MART STORES INC
Other names
SAMS PHARMACY 10-8135
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
4350 S US HIGHWAY 41, TERRE HAUTE, IN 47802-4407
(812) 238-5572
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
60005684A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200369090A
—
IN
05
—
200385960
—
IN
05
—
200385960A
—
IN
01
—
2024582
PK
—
Enumeration date
07/17/2006
Last updated
06/17/2025
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