Organization
SAMS EAST INC
Active
Parent organization
WAL-MART STORES INC
Other names
Sam's Pharmacy 10-6556
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
50555 VALLEY PLAZA DR, SAINT CLAIRSVILLE, OH 43950-1757
(740) 695-1263
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
021963050
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2120170
PK
—
05
—
3008935
—
OH
Enumeration date
05/07/2009
Last updated
06/16/2025
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