Organization
SAM'S EAST INC
Active
Parent organization
WAL-MART STORES INC
Other names
Sam's Pharmacy 10-8181
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
3805 NORTH BLVD, ALEXANDRIA, LA 71301-3563
(318) 442-9505
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
6142-RC
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235229
—
LA
01
—
2119771
PK
—
Enumeration date
04/08/2009
Last updated
06/18/2025
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