Provider Demographics
NPI:1851715999
Name:SAMS EAST INC
Entity Type:Organization
Organization Name:SAMS EAST INC
Other - Org Name:SAM'S CLUB PHARMACY 10-6269
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR GOV CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-204-8550
Mailing Address - Street 1:702 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72716-0445
Mailing Address - Country:US
Mailing Address - Phone:479-277-1242
Mailing Address - Fax:479-277-4331
Practice Address - Street 1:621 N EXPRESSWAY 77
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550
Practice Address - Country:US
Practice Address - Phone:956-507-7305
Practice Address - Fax:956-507-7316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX290013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144241OtherPK
TX470269Medicaid
TX1851715999Medicaid
TX470269Medicaid