Organization
SAMS EAST INC
Active
Other names
SAMS PHARMACY 10-6644
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3839 MUNDY MILL RD, OAKWOOD, GA 30566-3415
(770) 287-7716
Mailing address
MAIL STOP 0445, 702 SW 8TH ST, BENTONVILLE, AR 72716
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009463
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017400
PK
—
05
—
848583586A
—
GA
Enumeration date
04/03/2008
Last updated
06/17/2025
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