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General NPI Number Information
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NPI Number | 1386193902
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Entity Type | Organization
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Legal Business Name | SAMS CLUB
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 6520 CARLISLE PIKE STE 250
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City | MECHANICSBURG
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State | PA
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Zip | 17050-5251
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Country | US
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Telephone | 717-516-3772
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Fax | 717-516-3184
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Provider Business Mailing Address
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Address Line | 6520 CARLISLE PIKE STE 250
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City | MECHANICSBURG
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State | PA
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Zip | 17050-5251
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Country | US
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Telephone | 717-516-3772
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Fax | 717-516-3184
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | BRIDGET ROSE CROUSE
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Credential | PHARMD
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Telephone | 717-516-3772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | RP448459
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License Number State | PA
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