Organization
SAMS WEST INC
Active
Parent organization
WAL-MART STORES INC
Other names
SAMS PHARMACY 10-6549
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
412 EAGLERIDGE BLVD, PUEBLO, CO 81008-2100
(719) 553-0914
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
565
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2003701
PK
—
05
—
49234854
—
CO
Enumeration date
07/16/2006
Last updated
06/16/2025
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