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Provider Information for 1124045463


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SAMS WEST INC

Other Names:  
Doing Business As: 
SAMS PHARMACY 10-6379

Organization Subpart: YES

NPI: 1124045463
Last Updated: 2013-07-16
Certification Date:

Details

NameValue
NPI1124045463
Enumeration Date2006-07-16
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: LAURA LEVINE
Title: Mgr of Government Contracting
Phone: 4792048550
Mailing Address 702 SW 8TH ST
BENTONVILLE, AR 72716-0445
United States

Phone: | Fax:
 
Primary Practice Address 401 NORTHWEST BYP
GREAT FALLS, MT 59404-4124
United States

Phone: 406-453-3466 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)2052504PK
MEDICAIDMT0213741
MEDICAIDMT213741
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 333600000X - Pharmacy
No 332B00000X - Durable Medical Equipment & Medical Supplies
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyMT1112