Organization
SAMS EAST INC
Active
Other names
SAMS PHARMACY 10-6535
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
4000 RIB MOUNTAIN DR, WAUSAU, WI 54401-7483
(715) 355-0161
(715) 355-0186
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8690-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2110951
PK
—
05
—
33293700
—
WI
Enumeration date
10/12/2006
Last updated
06/16/2025
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