MEDICARE: SAM'S 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1700270014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAM'S 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	:	4062 LBJ FREEWAY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244
Country	:	US
Telephone Number	:	972-759-6492
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, HEALTHCARE CONTRACTING AN
Name	:	LAURA LEVINE
Credential	:
Telephone Number	:	479-204-8550

Provider Enumeration Date	:	03/25/2015
Last Update Date	:	08/07/2015

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