Active NPI
Sams West Inc
- Community/Retail Pharmacy
- Colorado Springs, CO
National Provider Identifier
1629095906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 240000104
- Legal business name
- SAMS WEST INC
- Practice address
- 1850 E Woodmen Rd
Colorado Springs, CO 80920-3326 - Phone
- (719) 277-0553
- NPI assigned
- Jul 16, 2006
- Organization subpart
- Yes
- Parent organization
- WAL-MART STORES INC
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 240000104 | CO | Primary |
Addresses
Primary practice location
1850 E Woodmen Rd
Colorado Springs, CO 80920-3326
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2003278 | Other | PK | |
| 60533781 | Medicaid | CO |
Other names 1
- SAMS PHARMACY 10-6219
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930091615 | CO | DME Supplier - Pharmacy | 1850412321 | Practice locations: Colorado Springs, CO |
| O20130731000496 | CO | Part B Supplier - Mass Immunization (Roster Biller Only) | 1850412321 |
16 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Thornton, CO; Pueblo, CO; Loveland, CO; Longmont, CO; Lone Tree, CO; Littleton, CO; Grand Junction, CO; Fort Collins, CO… |
Other NPIs on the same Medicare enrollment 16
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Sam'S Pharmacy 10-6219 | Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Ostomy Supplies|Prosthetic Lenses: Conventional Eyeglasses|Enteral Nutrients|Surgical Dressings | Accepts assignment |
National Provider Directory
National Provider Directory- Part of
- Walmart Pharmact
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": "1750032000000",
"number": "1629095906",
"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": "1850 E WOODMEN RD",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809203326",
"telephone_number": "719-277-0553"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SAMS WEST INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WAL-MART STORES INC",
"enumeration_date": "2006-07-16",
"last_updated": "2025-06-16",
"certification_date": "2025-06-16",
"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": "CO",
"license": "240000104",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2003278",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "60533781",
"state": "CO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "SAMS PHARMACY 10-6219",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.