Organization
SAMS WEST INC
Active
Other names
Sam's Pharmacy 10-6510
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1831 MADISON AVE, MANKATO, MN 56001-5449
(507) 387-4205
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-2611
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
264106
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417299793
—
MN
01
—
2139769
PK
—
Enumeration date
03/25/2013
Last updated
06/16/2025
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