NPIMap

Organization Active NPI

Sam's West Inc

Doing business as Sam's Pharmacy 10-7684

  • Pharmacy
  • Lathrop, CA
National Provider Identifier
1114847563
Registry record updated Jul 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
SAM'S WEST INC
Doing business as
Sam's Pharmacy 10-7684
Practice address
16150 Golden Vly Pkwy
Lathrop, CA 95330-8509
Phone
(209) 390-0343
Fax
(209) 390-0326
NPI assigned
Jul 16, 2026
Last updated
Jul 17, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kimberly Canonic
Title
Senior Director, Billing
Phone
(480) 853-0515

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

16150 Golden Vly Pkwy
Lathrop, CA 95330-8509

Mailing address

1 Customer Dr
Bentonville, AR 72716-0445

Other names 1

  • Sam's Pharmacy 10-7684 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ability Network283 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 16

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1784160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784246400000",
    "number": "1114847563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CUSTOMER DR",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16150 GOLDEN VLY PKWY",
            "city": "LATHROP",
            "state": "CA",
            "postal_code": "953308509",
            "telephone_number": "209-390-0343",
            "fax_number": "209-390-0326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAM'S WEST INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-07-16",
        "last_updated": "2026-07-17",
        "certification_date": "2026-07-17",
        "status": "A",
        "authorized_official_last_name": "CANONIC",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "SENIOR DIRECTOR, BILLING",
        "authorized_official_telephone_number": "480-853-0515"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sam's Pharmacy 10-7684",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lathrop, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.