Organization
SAMS WEST INC
Active
Parent organization
WAL-MART STORES INC
Other names
Sams Pharmacy 10-6565
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
925 EGLIN ST, RAPID CITY, SD 57701-9567
(605) 343-0231
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
100-1963
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295039451
—
SD
01
—
2128350
PK
—
Enumeration date
01/03/2011
Last updated
06/17/2025
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