Organization
SAMS EAST INC
Active
Parent organization
WAL-MART STORES INC
Other names
Sams Pharmacy 10-4875
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
3055 BEAR CREEK DR, WENTZVILLE, MO 63385-3502
(636) 698-9781
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2012034942
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790034528
—
MO
01
—
2136892
PK
—
Enumeration date
09/07/2012
Last updated
06/06/2025
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