Organization
SAMS EAST INC
Active
Parent organization
WAL-MART STORES INC
Other names
Sam's Club Pharmacy 10-4901
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
309 ROLLING HILLS CIR, EASLEY, SC 29640-7124
(864) 644-9012
(864) 644-9013
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
14647
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2140142
PK
—
05
—
714647
—
SC
Enumeration date
04/17/2013
Last updated
06/06/2025
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