Organization
SAMS WEST INC
Active
Other names
SAMS PHARMACY 10-6310
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
8150 UNIVERSITY AVE NE, FRIDLEY, MN 55432-1864
(763) 792-6653
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
261898
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018777100
—
MN
05
—
18777100
—
MN
01
—
2048226
PK
—
Enumeration date
07/16/2006
Last updated
06/17/2025
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