Organization
SAMS WEST INC
Active
Parent organization
WAL-MART STORES INC
Other names
Sam's Club Pharmacy 10-6425
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
4600 E 2ND ST, CASPER, WY 82609-4224
(307) 472-0124
(307) 472-0316
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
R10102
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2140700
PK
—
Enumeration date
06/07/2013
Last updated
06/16/2025
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