Organization
SAM'S WEST INC
Active
Other names
Sam's Pharmacy 10-7684
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, BILLING)
(480) 853-0515
Entity
Organization
Contact information
Practice address
16150 GOLDEN VLY PKWY, LATHROP, CA 95330-8509
(209) 390-0343
(209) 390-0326
Mailing address
1 CUSTOMER DR, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Enumeration date
07/16/2026
Last updated
07/17/2026
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