Active NPI
Sams East Inc
Doing business as Sams Pharmacy
- Community/Retail Pharmacy
- San Antonio, TX
National Provider Identifier
1306863444
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 20773
- Legal business name
- SAMS EAST INC
- Doing business as
- Sams Pharmacy
- Practice address
- 5565 Dezavala Rd
San Antonio, TX 78249 - Phone
- (210) 877-1572
- NPI assigned
- Jul 16, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kimberly Canonic
- Title
- Senior Director, Enrollment
- Phone
- (480) 853-0515
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 20773 | TX | Primary |
Addresses
Primary practice location
5565 Dezavala Rd
San Antonio, TX 78249
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 277-1238
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 469656 | Medicaid | TX | |
| 2095671 | Other | PK |
Other names 1
- SAMS PHARMACY
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930091567 | TX | DME Supplier - Pharmacy | 7012038581 | Practice locations: San Antonio, TX |
| O20121015000528 | TX | Part B Supplier - Mass Immunization (Roster Biller Only) | 7012038581 | This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Tax ID family
- Sam's Hearing Aid Center 6332
Organizations with this tax ID in the same state 24
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
dba Sam's Club Optical 30-6338
- Eyewear Supplier
- College Station, TX
- NPI 1356437164
Member of 2
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Sams Pharmacy 10-6240
- Community/Retail Pharmacy
- Glendora, CA
- NPI 1104843440
Member Of
-
dba Walmart Pharmacy 10-5274
- Community/Retail Pharmacy
- Pearl City, HI
- NPI 1174541650
Member Of
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153008000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1750118400000",
"number": "1306863444",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "702 SW 8TH ST",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727160445",
"telephone_number": "479-277-1238",
"fax_number": "479-277-4331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5565 DEZAVALA RD",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "78249",
"telephone_number": "210-877-1572"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SAMS EAST INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-16",
"last_updated": "2025-06-17",
"certification_date": "2025-06-17",
"status": "A",
"authorized_official_last_name": "CANONIC",
"authorized_official_first_name": "KIMBERLY",
"authorized_official_title_or_position": "SENIOR DIRECTOR, ENROLLMENT",
"authorized_official_telephone_number": "480-853-0515"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "TX",
"license": "20773",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "469656",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2095671",
"state": null
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.667.2",
"affiliationName": "Ability Network",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "100 N 6th St Ste 900A",
"city": "Minneapolis",
"state": "MN",
"country_code": "US",
"postal_code": "554031516",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "SAMS PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in San Antonio, TX
- Randi Lynn Sampson, PHARM D.
- Seth Allen Sampson, PH.D., LPC , NCC,CSC
- Sarah Samreen, MD
- Samri, LLC
- Sams Clinic LLC (San Antonio Muscle & Spine Clinic)
- Sams East Inc (Sam's Pharmacy 10-4914)
- Sams East Inc (Sam's Club Pharmacy 10-4939)
- Sams East Inc (Sams Pharmacy)
- Sams East Inc (Sams Pharmacy)
- Sams East Inc (Sams Pharmacy)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.