# SAMS WEST INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sam's Pharmacy 10-4987
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366801557
- **Authorized official:** SARAH LITTLE (DIR. HEALTHCARE CONTRACT & ENROLLME)
- **Authorized official phone:** (479) 277-2500

## Contact information

- **Practice address:** 1200 S HOVER ST, LONGMONT, CO 80501-7902
- **Practice address phone:** (303) 845-4219
- **Practice address fax:** (303) 682-6418
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (479) 204-8550
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | — | — |
| 333600000X | Pharmacy | PDO.1680000116 | CO | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | — | — |

## Other

- **Enumeration date:** 02/16/2016
- **Last updated:** 08/29/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1366801557 | — | CO |
| 01 | — | 2159365 | PK | — |