Organization
SAMS EAST INC
Active
Other names
Sams Pharmacy 10-8169
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3819 SOUTH ST, LAFAYETTE, IN 47905-4872
(765) 449-4309
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
60006302A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201080780 A
—
IN
01
—
2134305
PK
—
Enumeration date
03/02/2012
Last updated
06/18/2025
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