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Organization
SAMS WEST INC
Active
Organization
SAMS WEST INC
Active
Parent organization
WAL-MART STORES INC
Other names
SAMS PHARMACY 10-6686
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
1905 S 300 W, SALT LAKE CITY, UT 84115-1806
(801) 478-1695
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
63268951703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2100904
PK
—
Enumeration date
10/13/2006
Last updated
06/18/2025
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