# SAMS WEST INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WAL-MART STORES INC
- **Other names:** Sam's Pharmacy 10-4878
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1003158676
- **Legal business name:** WAL-MART STORES INC
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 277-6348

## Contact information

- **Practice address:** 5 ILLINI DR, GLEN CARBON, IL 62034-3929
- **Practice address phone:** (618) 692-7568
- **Practice address fax:** (618) 692-7633
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (479) 204-8705
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 054018277 | IL | Yes |

## Other

- **Enumeration date:** 03/21/2013
- **Last updated:** 06/06/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2140580 | PK | — |