MEDICARE: SAMS EAST INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	021328000	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2078696	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124045323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMS EAST INC

Provider Business Mailing Address
First Line	:	702 SW 8TH ST
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72716-0445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4790 PORTAGE ST NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-7245
Country	:	US
Telephone Number	:	330-497-7352
Fax Number	:

Authorized Official
Title or Position	:	SENIOR DIRECTOR, ENROLLMENT
Name	:	KIMBERLY CANONIC
Credential	:
Telephone Number	:	480-853-0515

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	06/17/2025

Similar Medicare Providers

1174831218 — CANTON PHYSICAL MEDICARE, LLC
Practice Location Address:

2050 CUMMING HWY , SUITE 100
CANTON, GA
30114-8614

Practice Phone: 770-345-9600
Practice Fax:

1679532345 — DR. HEATHER L ALCORN O.D
Practice Location Address:

4790 PORTAGE ST NW
NORTH CANTON, OH
44720-7245

Practice Phone: 330-497-8428
Practice Fax:

1821191453 — SAM'S CLUB OPTICAL
Practice Location Address:

4790 PORTAGE ST NW
NORTH CANTON, OH
44720-7245

Practice Phone: 330-497-5295
Practice Fax:

1629679683 — DR. MATTHEW TEAGUE PHARM. D
Practice Location Address:

4790 PORTAGE ST NW
NORTH CANTON, OH
44720-7245

Practice Phone: 330-497-7352
Practice Fax:

1104428721 — KIMBERLY ANNE RICHTERMAN RPH
Practice Location Address:

4790 PORTAGE ST NW
NORTH CANTON, OH
44720-7245

Practice Phone: 330-497-7352
Practice Fax:

1639533953 — MARY WILSON APN, NP
Practice Location Address:

7245 BOULEVARD 26
NORTH RICHLAND HILLS, TX
76180-8605

Practice Phone: 850-304-7986
Practice Fax:

Directions to “SAMS EAST INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.