Organization
SAMS EAST INC
Active
Other names
Sam's Pharmacy 10-4872
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIR HEALTHCARE CONTRACT&ENROL)
(479) 204-8550
Entity
Organization
Contact information
Practice address
733 FASHION DR, COLUMBIA, SC 29229-7936
(803) 223-0091
(803) 223-0977
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
16700
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2160446
PK
—
05
—
716700
—
SC
Enumeration date
05/27/2016
Last updated
08/29/2023
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