Organization
SAMS EAST INC
Active
Parent organization
WAL-MART STORES INC
Other names
Sam's Pharmacy 10-6443
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
2811 N PARK DR, GOLDSBORO, NC 27534-7485
(919) 778-8042
(919) 778-0696
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-6375
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
11519
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336582097
—
NC
01
—
2139856
PK
—
Enumeration date
04/12/2013
Last updated
06/16/2025
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