Provider Demographics
NPI:1326597816
Name:SAMS CLUB PHARMACY
Entity Type:Organization
Organization Name:SAMS CLUB PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GERST
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:717-561-0587
Mailing Address - Street 1:6781 GRAYSON RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-5138
Mailing Address - Country:US
Mailing Address - Phone:717-561-0587
Mailing Address - Fax:717-561-9942
Practice Address - Street 1:6781 GRAYSON RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-5138
Practice Address - Country:US
Practice Address - Phone:717-561-0587
Practice Address - Fax:717-561-9942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP1008138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP039365LOtherPHARMACY LICENSE