Organization
SAMS EAST INC
Active
Other names
Sam's Club Pharmacy 10-7676
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
8952 WESTGATE PKWY, AMARILLO, TX 79124-1782
(806) 513-6487
(479) 277-4331
Mailing address
702 SW 8TH ST, 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
30090
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2153540
PK
—
05
—
470970
—
TX
Enumeration date
08/11/2015
Last updated
06/06/2025
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