Organization
SAM'S EAST INC
Active
Other names
Sam's Pharmacy 10-6636
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3465 BERLIN TPKE, NEWINGTON, CT 06111-5106
(860) 665-7813
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PCY.0002129
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427298959
—
CT
01
—
2119282
PK
—
Enumeration date
02/24/2009
Last updated
06/17/2025
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