Organization
SAMS EAST INC
Active
Other names
Sam's Club Pharmacy 10-6867
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
22402 BELLAIRE BLVD, RICHMOND, TX 77407-3903
(281) 202-0345
(281) 202-0346
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
29431
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205237625
—
TX
01
—
2147706
PK
—
05
—
469164
—
TX
Enumeration date
09/05/2014
Last updated
06/09/2025
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