Organization
SAMS EAST INC
Active
Other names
Sam's Club Pharmacy 10-6188
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
10901 LAKELINE MALL DR, AUSTIN, TX 78717
(512) 872-8450
(512) 872-8451
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 204-8705
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
29432
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149505
PK
—
05
—
469683
—
TX
Enumeration date
10/08/2014
Last updated
06/09/2025
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