Organization
SAMS EAST INC
Active
Other names
Sam's Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1740 NORTH FM 157, MANSFIELD, TX 76063
(817) 779-6061
(817) 779-6060
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-0709
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28739
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568802270
—
TX
01
—
2141644
PK
—
05
—
469676
—
TX
Enumeration date
06/26/2013
Last updated
06/05/2025
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