Organization
SAM'S WEST, INC.
Active
Organization
SAM'S WEST, INC.
Active
Other names
Sam's Pharmacy 10-6275
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
3084 N MAIZE RD, WICHITA, KS 67205-7359
(316) 347-2587
(316) 347-2588
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2-13032
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100444790M
—
KS
01
—
2145369
PK
—
Enumeration date
04/16/2014
Last updated
06/09/2025
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