NPIMap

Organization Active NPI

Sam's Club Pharmacy

  • Community/Retail Pharmacy
  • Flint, MI
National Provider Identifier
1225186471
Registry record updated Jul 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301007744 Issued in MI
Legal business name
SAM'S CLUB PHARMACY
Practice address
4373 Corunna Rd
Flint, MI 48532-4152
Phone
(810) 733-0741
Fax
(810) 733-0997
NPI assigned
Jan 6, 2007
Last updated
Jul 28, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Sarah B Brooke
Title
Pharmacy Manager
Phone
(810) 733-0741

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 5301007744 MI Primary

Addresses

Primary practice location

4373 Corunna Rd
Flint, MI 48532-4152

Mailing address

4373 Corunna Rd
Flint, MI 48532-4152
Phone (810) 733-0741

Other identifiers 1

IdentifierTypeStateIssuer
2365080MedicaidMI

National Provider Directory

National Provider Directory
Tax ID family
Walmart15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217203200000",
    "number": "1225186471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4373 CORUNNA RD",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485324152",
            "telephone_number": "810-733-0741",
            "fax_number": "810-733-0997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4373 CORUNNA RD",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485324152",
            "telephone_number": "810-733-0741",
            "fax_number": "810-733-0997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAM'S CLUB PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-06",
        "last_updated": "2008-07-28",
        "status": "A",
        "authorized_official_last_name": "BROOKE",
        "authorized_official_first_name": "SARAH",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "810-733-0741",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301007744",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2365080",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flint, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.