Organization
SAMS EAST INC
Active
Parent organization
WAL-MART STORES INC
Other names
Sam's Club Pharmacy 10-8239
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
802 NW SHERIDAN RD, LAWTON, OK 73505-5204
(580) 248-3400
(580) 248-0363
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
3-6432
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100245300C
—
OK
01
—
2142213
PK
—
Enumeration date
09/23/2013
Last updated
06/17/2025
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