Organization
SAMS EAST INC
Active
Other names
Sam's Pharmacy 10-6781
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
201 GOLDEN TRIANGLE BLVD, KELLER, TX 76248-4484
(817) 898-6164
(817) 898-6163
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
31103
TX
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2167877
PK
—
Enumeration date
01/25/2017
Last updated
06/06/2025
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