NPIMap

Organization Active NPI

Sam's West Inc

Doing business as Sam's Pharmacy 10-4955

  • Community/Retail Pharmacy
  • Surprise, AZ
National Provider Identifier
1679718894
Registry record updated Aug 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
Y005062 Issued in AZ
Legal business name
SAM'S WEST INC
Doing business as
Sam's Pharmacy 10-4955
Practice address
16573 W Bell Rd
Surprise, AZ 85374-9892
Phone
(623) 584-0728
NPI assigned
Dec 3, 2008
Organization subpart
Yes
Parent organization
WAL-MART STORES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 30, 2023

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

Authorized official

Name
Laura Levine
Title
MGR of Government Contracting
Phone
(479) 204-8550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Y005062 AZ Primary

Addresses

Primary practice location

16573 W Bell Rd
Surprise, AZ 85374-9892

Mailing address

702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 277-1238

Other identifiers 1

IdentifierTypeStateIssuer
2118206OtherPK

Other names 1

  • Sam's Pharmacy 10-4955 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 AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930056250 AZ DME Supplier - Pharmacy 1850412321 Practice locations: Surprise, AZ
O20130808000006 AZ Part B Supplier - Mass Immunization (Roster Biller Only) 1850412321 12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Avondale, AZ; Yuma, AZ; Tucson, AZ; Tempe, AZ; Surprise, AZ; Phoenix, AZ; Gilbert, AZ; Flagstaff, AZ…

Other NPIs on the same Medicare enrollment 12

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

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
03D2126734Sam's Club Pharmacy 10-495516573 W Bell Rd, Surprise, AZ 85374Certificate of waiverMar 2, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Sam's Pharmacy 10-495516573 W Bell Rd, Surprise, AZ 85374-9892(623) 584-0728 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 assignmentParticipating since Nov 1, 2018

National Provider Directory

National Provider Directory
Tax ID family
Ability Network281 organizations share this tax ID, including this one
Part of
Walmart Pharmact

Organizations with this tax ID in the same state 19

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

View all 19

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": "1228262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693353600000",
    "number": "1679718894",
    "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",
            "telephone_number": "479-277-1238",
            "fax_number": "479-277-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16573 W BELL RD",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853749892",
            "telephone_number": "623-584-0728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAM'S WEST INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAL-MART STORES INC",
        "enumeration_date": "2008-12-03",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "MGR OF GOVERNMENT CONTRACTING",
        "authorized_official_telephone_number": "479-204-8550"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AZ",
            "license": "Y005062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2118206",
            "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 # A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Sam's Pharmacy 10-4955",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sam's Pharmacy 10-4955",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Surprise, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; 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.