Organization
SAMS WEST INC
Active
Organization
SAMS WEST INC
Active
Parent organization
WAL-MART STORES INC
Other names
SAMS PHARMACY 10-6382
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
7175 SPRING MOUNTAIN RD, LAS VEGAS, NV 89117-3819
(702) 247-1129
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH01487
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2051530
PK
—
05
—
2802696
—
NV
Enumeration date
07/16/2006
Last updated
06/16/2025
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