Organization
SAMS EAST INC
Active
Parent organization
WAL-MART STORES INC
Other names
SAMS PHARMACY 10-8150
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
10900 S US HIGHWAY 1, PORT SAINT LUCIE, FL 34952-6406
(772) 335-3992
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH22502
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031833001
—
FL
05
—
031899000
—
FL
01
—
2008136
PK
—
05
—
31899000
—
FL
Enumeration date
12/27/2006
Last updated
06/17/2025
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