Active NPI
Sams East Inc
Doing business as Sam's Club Pharmacy 10-6188
- Community/Retail Pharmacy
- Austin, TX
National Provider Identifier
1497158174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 29432
- Legal business name
- SAMS EAST INC
- Doing business as
- Sam's Club Pharmacy 10-6188
- Practice address
- 10901 Lakeline Mall Dr
Austin, TX 78717 - Phone
- (512) 872-8450
- Fax
- (512) 872-8451
- NPI assigned
- Oct 8, 2014
- 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) 277-6348
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | 29432 | TX | Primary |
Addresses
Primary practice location
10901 Lakeline Mall Dr
Austin, TX 78717
Mailing address
702 SW 8TH St
Bentonville, AR 72716-6209
Phone (479) 204-8705
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2149505 | Other | PK | |
| 469683 | Medicaid | TX |
Other names 1
- Sam's Club Pharmacy 10-6188
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 |
|---|---|---|---|---|
| O20121015000528 | TX | Part B Supplier - Mass Immunization (Roster Biller Only) | 7012038581 | This NPI is an additional NPI on the enrollment |
| O20150615002732 | TX | DME Supplier - Pharmacy | 7012038581 | Practice locations: Austin, TX |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Sam's Club Pharmacy 10-6188 | Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Ostomy Supplies|Prosthetic Lenses: Conventional Eyeglasses|Enteral Nutrients|Surgical Dressings | Does not accept assignment |
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.
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": "1412726400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1749427200000",
"number": "1497158174",
"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": "727166209",
"telephone_number": "479-204-8705",
"fax_number": "479-277-4331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10901 LAKELINE MALL DR",
"city": "AUSTIN",
"state": "TX",
"postal_code": "78717",
"telephone_number": "512-872-8450",
"fax_number": "512-872-8451"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SAMS EAST INC",
"organizational_subpart": "NO",
"enumeration_date": "2014-10-08",
"last_updated": "2025-06-09",
"certification_date": "2025-06-09",
"status": "A",
"authorized_official_last_name": "CANONIC",
"authorized_official_first_name": "KIMBERLY",
"authorized_official_title_or_position": "SENIOR DIRECTOR, ENROLLMENT",
"authorized_official_telephone_number": "480-277-6348"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "TX",
"license": "29432",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2149505",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "469683",
"state": "TX"
}
],
"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": "Sam's Club Pharmacy 10-6188",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.