Organization
SAMS WEST INC
Active
Other names
Sam's Club Pharmacy 10-6388
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1050 OGDEN AVE, MONTGOMERY, IL 60538-5404
(630) 449-1953
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-4000
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054.018634
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2145248
PK
—
Enumeration date
03/24/2014
Last updated
06/09/2025
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