Organization
SAMS EAST INC
Active
Organization
SAMS EAST INC
Active
Parent organization
WAL-MART STORES INC
Other names
SAMS PHARMACY 10-6518
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
21483 MARKET CENTER, BRISTOL, VA 24202-5963
(276) 466-4727
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201004184
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063612620
—
VA
01
—
2106297
PK
—
05
—
4582512
—
TN
Enumeration date
07/23/2007
Last updated
06/16/2025
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