Organization
SAMS EAST INC
Active
Other names
Sam's Pharmacy 10-6331
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3300 BRUMBACK BLVD, KENOSHA, WI 53144-4815
(262) 654-6854
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8932-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100004560
—
WI
01
—
2120429
PK
—
Enumeration date
05/19/2009
Last updated
06/16/2025
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