Organization
SAMS EAST INC
Active
Parent organization
WAL-MART STORES INC
Other names
SAMS PHARMACY 10-8225
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
4701 LOG CABIN DR, MACON, GA 31204-6318
(478) 788-6774
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE008648
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00885013L
—
GA
01
—
2014664
PK
—
Enumeration date
07/16/2006
Last updated
06/17/2025
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