Active NPI
Sams West Inc
Doing business as Sam's Club Pharmacy 10-6425
- Community/Retail Pharmacy
- Casper, WY
National Provider Identifier
1891133286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- R10102
- Legal business name
- SAMS WEST INC
- Doing business as
- Sam's Club Pharmacy 10-6425
- Practice address
- 4600 E 2ND St
Casper, WY 82609-4224 - Phone
- (307) 472-0124
- Fax
- (307) 472-0316
- NPI assigned
- Jun 7, 2013
- Last updated
- Jun 16, 2025
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | R10102 | WY | Primary |
Addresses
Primary practice location
4600 E 2ND St
Casper, WY 82609-4224
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2140700 | Other | PK |
Other names 1
- Sam's Club Pharmacy 10-6425
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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 WY
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131127000286 | WY | DME Supplier - Pharmacy | 1850412321 | Practice locations: Casper, WY |
| O20131217002024 | WY | Part B Supplier - Mass Immunization (Roster Biller Only) | 1850412321 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Casper, WY; Cheyenne, WY |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Sam's Club Pharmacy 10-6430
- Community/Retail Pharmacy
- Cheyenne, WY
- NPI 1588006233
O20131217002024
National Provider Directory
National Provider Directory- Tax ID family
- Ability Network
- Part of
- Walmart Pharmacy 10-206
Organizations with this tax ID in the same state 3
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
Member of 2
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Walmart Pharmacy 10-1588
- Community/Retail Pharmacy
- Victorville, CA
- NPI 1043237456
Member Of
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1370563200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1750032000000",
"number": "1891133286",
"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": "4600 E 2ND ST",
"city": "CASPER",
"state": "WY",
"postal_code": "826094224",
"telephone_number": "307-472-0124",
"fax_number": "307-472-0316"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SAMS WEST INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WAL-MART STORES INC",
"enumeration_date": "2013-06-07",
"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": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "WY",
"license": "R10102",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2140700",
"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": "Sam's Club Pharmacy 10-6425",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Casper, WY
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.