Organization
SAMS WEST INC
Active
Organization
SAMS WEST INC
Active
Other names
Sam's Pharmacy 10-6612
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1225 CONCORD AVE, CONCORD, CA 94520-4940
(925) 349-2472
Mailing address
702 SW8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
51768
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558785543
—
CA
01
—
2144256
PK
—
Enumeration date
02/11/2014
Last updated
06/17/2025
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