NPIMap

Organization Active NPI

Sam'S Club Pharmacy

  • Pharmacist
  • Bloomington, IN
National Provider Identifier
1487744678
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
26017690A Issued in IN
Legal business name
SAM'S CLUB PHARMACY
Practice address
3205 W State Road 45
Bloomington, IN 47403-5107
Phone
(812) 333-8903
Fax
(812) 333-8906
NPI assigned
Oct 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Steven Michael Ridge
Title
Phamacy Manager
Phone
(812) 333-8903

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193400000X SINGLE SPECIALTY GROUP 183500000X 26017690A IN Primary

Addresses

Primary practice location

3205 W State Road 45
Bloomington, IN 47403-5107

Mailing address

7463 N State Road 37
Bloomington, IN 47404-9440
Phone (812) 876-4964

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2136086Sam'S Club Pharmacy 10-64373205 West State Hwy 45, Bloomington, IN 47403Certificate of waiverAug 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
Sam'S Hearing Aid Center 6332819 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 23

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487744678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7463 N STATE ROAD 37",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474049440",
            "telephone_number": "812-876-4964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3205 W STATE ROAD 45",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474035107",
            "telephone_number": "812-333-8903",
            "fax_number": "812-333-8906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAM'S CLUB PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RIDGE",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PHAMACY MANAGER",
        "authorized_official_telephone_number": "812-333-8903"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "IN",
            "license": "26017690A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.