NPIMap

Organization Active NPI

Sams East Inc

Doing business as Sam's Club Pharmacy 10-6302

  • Community/Retail Pharmacy
  • Oakwood Village, OH
National Provider Identifier
1639557838
Registry record updated Jun 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
022499950-03 Issued in OH
Legal business name
SAMS EAST INC
Doing business as
Sam's Club Pharmacy 10-6302
Practice address
23300 Broadway Ave
Oakwood Village, OH 44146-6016
Phone
(440) 201-1187
Fax
(440) 201-1188
NPI assigned
May 8, 2015
Last updated
Jun 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2025

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X 022499950-03 OH Primary

Addresses

Primary practice location

23300 Broadway Ave
Oakwood Village, OH 44146-6016

Mailing address

702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 258-2115

Other identifiers 2

IdentifierTypeStateIssuer
0155541MedicaidOH
2152009OtherPK

Other names 1

  • Sam's Club Pharmacy 10-6302 Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
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 OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130730000993 OH Part B Supplier - Mass Immunization (Roster Biller Only) 7012038581 27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Boardman, OH; Zanesville, OH; Washington Township, OH; Warren, OH; South Point, OH; Sheffield Village, OH; Sandusky, OH; Saint Clairsville, OH…
O20150923000635 OH DME Supplier - Pharmacy 7012038581 Practice locations: Oakwood Village, OH

Other NPIs on the same Medicare enrollment 25

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 25

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
36D2133285Sam's Club Pharmacy 10-630223300 Broadway Ave, Oakwood Village, OH 44146Certificate of waiverJul 9, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Sam's Pharmacy 10-630223300 Broadway Ave, Oakwood Village, OH 44146-6016(440) 201-1187 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 assignmentParticipating since May 15, 2013

National Provider Directory

National Provider Directory
Tax ID family
Sams Club Optical823 organizations share this tax ID, including this one

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.

View all 24

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

  • Sams West Inc

    dba Sams Pharmacy

    • Community/Retail Pharmacy
    • Hodgkins, IL
    • NPI 1760409056

    Member Of

    NPD member
  • Walmart Inc.

    dba Walmart Pharmacy 10-2050

    • Community/Retail Pharmacy
    • Henderson, NV
    • NPI 1043237142

    Member Of

    NPD member

Locations

23300 Broadway Ave
Oakwood Village, OH 44146
Phone (440) 201-1187

NPI Registry JSON

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

{
    "created_epoch": "1431043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750118400000",
    "number": "1639557838",
    "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": "479-258-2115",
            "fax_number": "479-277-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23300 BROADWAY AVE",
            "city": "OAKWOOD VILLAGE",
            "state": "OH",
            "postal_code": "441466016",
            "telephone_number": "440-201-1187",
            "fax_number": "440-201-1188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMS EAST INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-08",
        "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": "022499950-03",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0155541",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2152009",
            "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": "Sam's Club Pharmacy 10-6302",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oakwood Village, OH

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.
  • 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.