Organization
SAMS EAST INC
Active
Other names
Sam's Pharmacy 10-6505
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
849 STONERIDGE PKWY, JEFFERSON CITY, MO 65109-5034
(479) 204-8850
(479) 277-4331
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2015021516
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134514391
—
MO
01
—
2151852
PK
—
Enumeration date
04/03/2015
Last updated
06/06/2025
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