Organization
SAMS EAST INC
Active
Parent organization
WAL-MART STORES INC
Other names
Sam's Pharmacy #10-6238
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAL-MART STORES INC
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
12905 E 96TH ST N, OWASSO, OK 74055-4719
(918) 212-7041
(918) 212-7042
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-0709
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
26358
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100245300B
—
OK
01
—
2141704
PK
—
Enumeration date
06/26/2013
Last updated
06/05/2025
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