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General NPI Number Information
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NPI Number | 1497209738
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Entity Type | Organization
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Legal Business Name | SAM'S CLUB
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 10735 W FLORISSANT AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63136-2403
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Country | US
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Telephone | 314-522-3420
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Fax |
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Provider Business Mailing Address
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Address Line | 4528 FORDER OAKS DR
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City | SAINT LOUIS
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State | MO
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Zip | 63129-7103
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Country | US
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Telephone | 314-229-0984
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. SAMIRAH SHAFFIQ DAY
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Credential |
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Telephone | 314-522-3420
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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 | 2013026228
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License Number State | MO
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