Organization
SAMS WEST INC
Active
Parent organization
WAL-MART STORES INC
Other names
SAMS PHARMACY
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
4100 W WILLOW KNOLLS DR, PEORIA, IL 61615-4405
(309) 692-1508
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054014796
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021246
PK
—
Enumeration date
07/16/2006
Last updated
06/18/2025
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