Organization
SAMS EAST INC
Active
Other names
SAMS PHARMACY 10-8174
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3134 E 79TH AVE, MERRILLVILLE, IN 46410-5738
(219) 947-3789
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
60005662A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200369080
—
IN
05
—
200369080A
—
IN
01
—
2024523
PK
—
Enumeration date
07/16/2006
Last updated
06/18/2025
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