NPIMap

Organization Active NPI

Sam's West, Inc.

Doing business as Sams Pharmacy

  • Community/Retail Pharmacy
  • Gurnee, IL
National Provider Identifier
1306863691
Registry record updated Jun 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
54014456 Issued in IL
Legal business name
SAM'S WEST, INC.
Doing business as
Sams Pharmacy
Sam's Pharmacy 10-8184
Practice address
6570 Grand Ave
Gurnee, IL 60031-1621
Phone
(847) 855-8620
NPI assigned
Jul 16, 2006
Last updated
Jun 18, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
WALMART INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 18, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kimberly Canonic
Title
Senior Director, Enrollment
Phone
(480) 853-0515

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 54014456 IL Primary

Addresses

Primary practice location

6570 Grand Ave
Gurnee, IL 60031-1621

Mailing address

702 SW 8TH St
Bentonville, AR 72716-0445

Other identifiers 1

IdentifierTypeStateIssuer
1473052OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 2

  • SAMS PHARMACY Doing business as
  • Sam's Pharmacy 10-8184 Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930053903 IL DME Supplier - Pharmacy 1850412321 Practice locations: Gurnee, IL
O20130614000252 IL Part B Supplier - Mass Immunization (Roster Biller Only) 1850412321 30 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Vernon Hills, IL; Springfield, IL; Rockford, IL; Quincy, IL; Peoria, IL; O Fallon, IL; Northlake, IL; Normal, IL…

Other NPIs on the same Medicare enrollment 23

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 23

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2132996Sam's Club Pharmacy 10-81846570 Grand Ave, Gurnee, IL 60031Certificate of waiverJul 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Ability Network283 organizations share this tax ID, including this one
Part of
Walmart Pharmacy 0026

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750204800000",
    "number": "1306863691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SW 8TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6570 GRAND AVE",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600311621",
            "telephone_number": "847-855-8620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAM'S WEST, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALMART INC.",
        "enumeration_date": "2006-07-16",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A",
        "authorized_official_last_name": "CANONIC",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "SENIOR DIRECTOR, ENROLLMENT",
        "authorized_official_telephone_number": "480-853-0515"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "54014456",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1473052",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "SAMS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sam's Pharmacy 10-8184",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gurnee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.