# SAM'S WEST INC

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

## Provider details

- **NPI number:** 1306087820
- **Legal business name:** WAL-MART STORES INC
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 853-0515

## Contact information

- **Practice address:** 2709 WALTON WAY, MARION, IL 62959-4901
- **Practice address phone:** (618) 997-8945
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-6209
- **Mailing address phone:** (479) 277-2500
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 54016630 | IL | Yes |

## Other

- **Enumeration date:** 03/12/2009
- **Last updated:** 06/18/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1483041 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |