Organization
SAMS WEST INC
Active
Other names
Sam's Club Pharmacy 10-6181
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
9851 S 71ST PLZ, PAPILLION, NE 68133-2244
(402) 686-2393
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-3348
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
3033
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100264218-00
—
NE
01
—
2147246
PK
—
Enumeration date
07/09/2014
Last updated
06/09/2025
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