Organization
SAMS EAST INC
Active
Other names
Sam's Club Pharmacy 10-6779
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1705 S BROADWAY ST, MOORE, OK 73160-5364
(405) 300-6027
(405) 300-6028
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
7-7154
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100246790L
—
OK
01
—
2150365
PK
—
Enumeration date
02/16/2015
Last updated
06/06/2025
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