Organization
SAMS EAST INC
Active
Other names
Sam's Pharmacy 10-6245
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
600 W CENTRAL TEXAS EXPY, HARKER HEIGHTS, TX 76548-1677
(254) 415-4892
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8705
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28740
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033559927
—
TX
01
—
2141003
PK
—
05
—
469688
—
TX
Enumeration date
06/25/2013
Last updated
06/05/2025
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