Organization
SAM'S WEST, INC.
Active
Parent organization
WALMART INC.
Other names
SAMS PHARMACY, Sam's Pharmacy 10-8184
Organization subpart
Yes
Provider details
NPI number
Legal business name
WALMART INC.
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
6570 GRAND AVE, GURNEE, IL 60031-1621
(847) 855-8620
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
54014456
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1473052
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/16/2006
Last updated
06/18/2025
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