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General NPI Number Information
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NPI Number | 1659752145
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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 | 06/10/2015
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Last Update Date | 06/10/2015
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Provider Practice Location Address
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Address Line | 600 HIGHWAY 95
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City | BULLHEAD CITY
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State | AZ
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Zip | 86429-5007
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Country | US
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Telephone | 928-754-3950
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Fax |
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Provider Business Mailing Address
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Address Line | 600 HIGHWAY 95
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City | BULLHEAD CITY
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State | AZ
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Zip | 86429-5007
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Country | US
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Telephone | 928-754-3950
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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. RICHARD STANLEY DOUGLASS
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Credential | RPH
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Telephone | 928-754-3950
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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 | S019426
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License Number State | AZ
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