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General NPI Number Information
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NPI Number | 1326597816
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Entity Type | Organization
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Legal Business Name | SAMS CLUB PHARMACY
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Dates
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Enumeration Date | 09/26/2016
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Last Update Date | 09/26/2016
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Provider Practice Location Address
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Address Line | 6781 GRAYSON RD
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City | HARRISBURG
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State | PA
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Zip | 17111-5138
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Country | US
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Telephone | 717-561-0587
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Fax | 717-561-9942
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Provider Business Mailing Address
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Address Line | 6781 GRAYSON RD
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City | HARRISBURG
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State | PA
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Zip | 17111-5138
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Country | US
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Telephone | 717-561-0587
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Fax | 717-561-9942
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. MARK ANTHONY GERST
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Credential | R. PH.
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Telephone | 717-561-0587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP1008138
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License Number State | PA
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