Organization
SAM'S EAST, INC.
Active
Other names
Sam's Pharmacy 10-7673
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (DIRECTOR OF HEALTH CARE CONTRACTING)
(480) 277-6348
Entity
Organization
Contact information
Practice address
600 WILLARD HAGAN DR, LEBANON, TN 37090
(615) 994-4122
Mailing address
1 CUSTOMER DRIVE, MS 0445, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Enumeration date
08/26/2025
Last updated
08/26/2025
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