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Organization
SAMS EAST INC
Active
Organization
SAMS EAST INC
Active
Other names
SAM'S PHARMACY 10-6321
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1000 N WESTHILL BLVD, APPLETON, WI 54914-5792
(920) 733-7410
(920) 733-7672
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
8214-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2109995
PK
—
05
—
33264400
—
WI
Enumeration date
07/16/2006
Last updated
06/16/2025
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