Organization
SAMS EAST INC
Active
Other names
Sam's Club Pharmacy 10-6302
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
23300 BROADWAY AVE, OAKWOOD VILLAGE, OH 44146-6016
(440) 201-1187
(440) 201-1188
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 258-2115
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
022499950-03
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0155541
—
OH
01
—
2152009
PK
—
Enumeration date
05/08/2015
Last updated
06/17/2025
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