Organization
SAMS EAST INC
Active
Other names
Sam's Pharmacy 10-8189
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
200 EMILY DR, CLARKSBURG, WV 26301-5500
(304) 918-6056
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 277-2500
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
MP0552415
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2150860
PK
—
05
—
3910006996
—
WV
Enumeration date
03/11/2015
Last updated
06/18/2025
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