Organization
SAMS WEST INC
Active
Other names
SAMS PHARMACY 10-6320
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIR H&W)
(479) 204-8550
Entity
Organization
Contact information
Practice address
4743 MAPLE GROVE RD, HERMANTOWN, MN 55811-3920
(218) 279-2858
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
261982
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2048190
PK
—
05
—
20672200
—
MN
05
—
220672200
—
MN
Enumeration date
07/16/2006
Last updated
08/24/2023
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