Organization
SAM'S CLUB PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN MICHAEL RIDGE (PHAMACY MANAGER)
(812) 333-8903
Entity
Organization
Contact information
Practice address
3205 W STATE ROAD 45, BLOOMINGTON, IN 47403-5107
(812) 333-8903
(812) 333-8906
Mailing address
7463 N STATE ROAD 37, BLOOMINGTON, IN 47404-9440
(812) 876-4964
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26017690A
IN
Other
Enumeration date
10/16/2006
Last updated
08/22/2020
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