Organization
SAMS EAST INC
Active
Other names
Sam's Club Pharmacy 10-8158
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIR HEALTHCARE CONTRACT&ENROLL)
(479) 204-8550
Entity
Organization
Contact information
Practice address
9464 MAIN ST, WOODSTOCK, GA 30188-3715
(678) 402-0532
(678) 402-0531
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010186
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003168959A
—
GA
01
—
2154300
PK
—
Enumeration date
09/08/2015
Last updated
08/29/2023
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