Organization
SAMS EAST INC
Active
Other names
Sam's Club Pharmacy 10-6247
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
8130 N CHURCH RD, KANSAS CITY, MO 64158-1101
(816) 439-4014
(816) 439-4015
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2014016142
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902223019
—
MO
01
—
2144991
PK
—
Enumeration date
03/26/2014
Last updated
06/09/2025
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