Provider Demographics
NPI:1386193902
Name:SAMS CLUB
Entity Type:Organization
Organization Name:SAMS CLUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:CROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:717-516-3772
Mailing Address - Street 1:6520 CARLISLE PIKE STE 250
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-5251
Mailing Address - Country:US
Mailing Address - Phone:717-516-3772
Mailing Address - Fax:717-516-3184
Practice Address - Street 1:6520 CARLISLE PIKE STE 250
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-5251
Practice Address - Country:US
Practice Address - Phone:717-516-3772
Practice Address - Fax:717-516-3184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP4484593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy