Organization
SAM'S EAST INC
Active
Parent organization
WAL-MART STORES INC
Other names
Sams Pharmacy 10-6524
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
735 SOUTHPARK BLVD, COLONIAL HEIGHTS, VA 23834-3605
(804) 520-4182
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
0201004280
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2119136
PK
—
Enumeration date
02/20/2009
Last updated
06/16/2025
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