Organization
SAMS WEST INC
Active
Parent organization
WAL-MART STORES INC
Other names
Sam's Club Pharmacy 10-6430
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
1948 DELL RANGE BLVD, CHEYENNE, WY 82009-4917
(307) 637-3771
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 273-4885
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
R10103
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2141319
PK
—
Enumeration date
07/23/2013
Last updated
06/16/2025
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