Organization
SAMS EAST INC
Active
Parent organization
WAL-MART STORES INC
Other names
Sam's Pharmacy 10-6463
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
3812 LIBERTY HWY STE 6, ANDERSON, SC 29621-1344
(864) 226-7729
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
13933
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2134857
PK
—
05
—
713933
—
SC
05
—
DE3497 DME
—
SC
Enumeration date
04/18/2012
Last updated
06/17/2025
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