Organization
SAMS EAST INC
Active
Other names
Sam's Club Pharmacy 10-7189
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
4101 N MAY AVE, OKLAHOMA CITY, OK 73112
(405) 200-0363
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 204-1258
(479) 277-2331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
17521
OK
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100246790M
—
OK
01
—
2157809
PK
—
Enumeration date
01/15/2016
Last updated
06/09/2025
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