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	PH19610	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2015773	OTHER	PK

General Provider Information

NPI Number	:	1942227350
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	:	4255 W NEW HAVEN AVE
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32904-3317
Country	:	US
Telephone Number	:	321-768-0438
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

1689763286 — SAM'S CLUB OPTICAL
Practice Location Address:

4255 W NEW HAVEN AVE
MELBOURNE, FL
32904-3317

Practice Phone: 321-768-8190
Practice Fax:

1750983680 — DR. MATTHEW HODGE PHARMD
Practice Location Address:

4255 W NEW HAVEN AVE
MELBOURNE, FL
32904-3317

Practice Phone: 321-768-0438
Practice Fax: 321-768-8084

1982184610 — CHARLENE W MORRIS LMHC
Practice Location Address:

2475 PALM BAY RD NE STE 145-23
MELBOURNE, FL
32905-3317

Practice Phone: 321-345-6831
Practice Fax:

1972455756 — ABA DYNAMIC LEARNING LLC
Practice Location Address:

3020 W NEW HAVEN AVE STE 120
WEST MELBOURNE, FL
32904-3565

Practice Phone: 561-497-5612
Practice Fax:

1740546506 — STEPHANIE MARIE STEEN MA
Practice Location Address:

1341 OLDE BAILEY LN
MELBOURNE, FL
32904-8025

Practice Phone: 321-412-0177
Practice Fax:

1083980437 — YANNA WILLS APRN
Practice Location Address:

4478 ALLIGATOR FLAG CIR
WEST MELBOURNE, FL
32904-8198

Practice Phone: 561-898-2337
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 © 2007-2026 (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.