Organization
SAMS EAST INC
Active
Other names
Sam's Pharmacy 10-8155
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
4001 SW 30TH PL, GAINESVILLE, FL 32608-1907
(352) 339-7937
(352) 339-7922
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 258-6180
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
PH30177
FL
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017728100
—
FL
01
—
2160148
PK
—
Enumeration date
04/12/2016
Last updated
06/17/2025
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