Organization
SAMS EAST INC
Active
Other names
Sam's Pharmacy 10-4914
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2530 MARSHALL RD, SAN ANTONIO, TX 78259-1608
(210) 810-4202
(210) 810-4369
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
28998
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336576149
—
TX
01
—
2143329
PK
—
05
—
469666
—
TX
Enumeration date
10/11/2013
Last updated
06/06/2025
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