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	333600000X	Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0003X	Community/Retail Pharmacy	19666	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2092564	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568489672
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	:	479-277-1238
Fax Number	:	479-277-4331

Provider Business Practice Location Address
First Line	:	12205 WEST RD
Second Line	:
City	:	JERSEY VILLAGE
State	:	TX
Zip	:	77065-4522
Country	:	US
Telephone Number	:	281-807-5194
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

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Directions to “SAMS EAST INC ” Practice Location

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