Organization
SAMS EAST INC
Active
Parent organization
WAL-MART STORES INC
Other names
Sam's Pharmacy 10-6267
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAL-MART STORES INC
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1117 W I-35 FRONTAGE RD., EDMOND, OK 73034
(405) 757-3802
(405) 757-3251
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1-6347
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100246790J
—
OK
01
—
2141155
PK
—
Enumeration date
06/26/2013
Last updated
06/09/2025
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