Organization
SAMS WEST INC
Active
Other names
Sam's Pharmacy 10-4787
Organization subpart
No
Provider details
NPI number
Authorized official
CORY JON GUNDBERG (SVP)
(479) 277-2500
Entity
Organization
Contact information
Practice address
200 AMERICAN BLVD W, BLOOMINGTON, MN 55420-1120
(952) 888-6079
(952) 888-6095
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 258-6724
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
262274
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2048384
PK
—
05
—
470053800
—
MN
Enumeration date
07/16/2006
Last updated
08/29/2023
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