Organization
SAMS EAST INC
Active
Parent organization
WAL-MART STORES INC
Other names
Sam's Pharmacy 10-6520
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
5565 20TH ST, VERO BEACH, FL 32966-4632
(772) 978-7701
Mailing address
5565 20TH ST, VERO BEACH, FL 32966-4632
(772) 978-7701
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH23624
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2117281
PK
—
Enumeration date
09/12/2008
Last updated
06/16/2025
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