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Provider Information for 1558388892


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SAMS EAST INC

Other Names:  
Doing Business As: 
SAMS PHARMACY 10-4780

Organization Subpart: YES

NPI: 1558388892
Last Updated: 2023-08-29
Certification Date: 2023-08-29

Details

NameValue
NPI1558388892
Enumeration Date2006-07-16
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: LAURA LEVINE
Title: Mgr of Government Contracting
Phone: 4792048550
Mailing Address 702 SW 8TH ST
BENTONVILLE, AR 72716-0445
United States

Phone: | Fax:
 
Primary Practice Address 3383 BUFORD DR
BUFORD, GA 30519-4985
United States

Phone: 770-831-8182 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
CONNECT URL
https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service
2.16.840.1.113883.3.667.2
CMS esMD eMDR Ability Network 100 N 6th St Ste 900A
Minneapolis, MN 55403-1516
United States
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDGA00885013E
Other (non-Medicare)2014403PK
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 333600000X - Pharmacy
No 332B00000X - Durable Medical Equipment & Medical Supplies
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyGAPHRE008543