Organization
SAM'S WEST INC
Active
Parent organization
WAL-MART STORES INC
Other names
Sam's 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
2709 WALTON WAY, MARION, IL 62959-4901
(618) 997-8945
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
54016630
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1483041
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/12/2009
Last updated
06/18/2025
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