Organization
SAMS EAST INC
Active
Other names
Sam's Pharmacy 10-6976
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
11460 ROYALL COTTON ROAD, WAKE FOREST, NC 27587-0000
(919) 263-6124
(919) 263-6123
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 204-1258
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164870366 NPI
—
NC
01
—
2160527
PK
—
Enumeration date
05/27/2016
Last updated
06/09/2025
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