NPIMap

Organization Active NPI

Sams East Inc

  • Community/Retail Pharmacy
  • Tuscaloosa, AL
National Provider Identifier
1235409608
Registry record updated Jun 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
113876 Issued in AL
Legal business name
SAMS EAST INC
Practice address
1401 Skyland Blvd E
Tuscaloosa, AL 35405-4229
Phone
(205) 345-2016
NPI assigned
Jan 3, 2012
Organization subpart
Yes
Parent organization
WAL-MART STORES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kimberly Canonic
Title
Senior Director, Enrollment
Phone
(480) 853-0515

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X 113876 AL Primary

Addresses

Primary practice location

1401 Skyland Blvd E
Tuscaloosa, AL 35405-4229

Mailing address

702 SW 8TH St
Bentonville, AR 72716-6209
Phone (479) 277-1238

Other identifiers 2

IdentifierTypeStateIssuer
147783MedicaidAL
2133390OtherPK

Other names 1

  • Sams Pharmacy 10-6435 Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130805000472 AL Part B Supplier - Mass Immunization (Roster Biller Only) 7012038581 12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tuscaloosa, AL; Oxford, AL; Montgomery, AL; Mobile, AL; Homewood, AL; Huntsville, AL; Hoover, AL; Auburn, AL…
O20130903000309 AL DME Supplier - Pharmacy 7012038581 Practice locations: Tuscaloosa, AL

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Sam'S Hearing Aid Center 6332819 organizations share this tax ID, including this one
Part of
Walmart Pharmact

Organizations with this tax ID in the same state 16

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 16

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1325548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750032000000",
    "number": "1235409608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SW 8TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727166209",
            "telephone_number": "479-277-1238",
            "fax_number": "479-277-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 SKYLAND BLVD E",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354054229",
            "telephone_number": "205-345-2016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMS EAST INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAL-MART STORES INC",
        "enumeration_date": "2012-01-03",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-16",
        "status": "A",
        "authorized_official_last_name": "CANONIC",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "SENIOR DIRECTOR, ENROLLMENT",
        "authorized_official_telephone_number": "480-853-0515"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AL",
            "license": "113876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "147783",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2133390",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Sams Pharmacy 10-6435",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tuscaloosa, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.