Provider Demographics
NPI:1386193027
Name:SAM'S CLUB PHARMACY
Entity Type:Organization
Organization Name:SAM'S CLUB PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SINEAD
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:GEARY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:570-546-3513
Mailing Address - Street 1:611 LYCOMING MALL CIR
Mailing Address - Street 2:
Mailing Address - City:MUNCY
Mailing Address - State:PA
Mailing Address - Zip Code:17756-1826
Mailing Address - Country:US
Mailing Address - Phone:570-546-3513
Mailing Address - Fax:570-546-3684
Practice Address - Street 1:611 LYCOMING MALL CIR
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-1826
Practice Address - Country:US
Practice Address - Phone:570-546-3513
Practice Address - Fax:570-546-3684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP4457673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy