Organization
SAMS EAST INC
Active
Parent organization
WAL-MART STORES INC
Other names
Sams Pharmacy 10-6373
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
1100 GRAND CENTRAL AVE, VIENNA, WV 26105-1049
(304) 295-0280
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
MP0552397
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2134310
PK
—
05
—
3810027392
—
WV
Enumeration date
03/12/2012
Last updated
06/16/2025
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