NPIMap

Organization Active NPI

Sams East Inc

  • Community/Retail Pharmacy
  • Elmira, NY
National Provider Identifier
1750499141
Registry record updated Jun 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
28015 Issued in NY
Legal business name
SAMS EAST INC
Practice address
830 County Road 64 Ste 2
Elmira, NY 14903-9716
Phone
(607) 739-6103
NPI assigned
Aug 27, 2006
Organization subpart
Yes
Parent organization
WAL-MART STORES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 16, 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 28015 NY Primary

Addresses

Primary practice location

830 County Road 64 Ste 2
Elmira, NY 14903-9716

Mailing address

702 SW 8TH St
Bentonville, AR 72716-0445

Other identifiers 2

IdentifierTypeStateIssuer
2068219OtherPK
2860020MedicaidNY

Other names 1

  • SAMS PHARMACY 10-6431 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930069862 NY DME Supplier - Pharmacy 7012038581 Practice locations: Elmira, NY
O20130919000716 NY Part B Supplier - Mass Immunization (Roster Biller Only) 7012038581 11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Medford, NY; Middletown, NY; Niagara Falls, NY; Vestal, NY; Fishkill, NY; Elmsford, NY; Latham, NY; Cheektowaga, NY…

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

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

Organizations with this tax ID in the same state 15

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

View all 15

Member of 2

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750032000000",
    "number": "1750499141",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 COUNTY ROAD 64 STE 2",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149039716",
            "telephone_number": "607-739-6103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMS EAST INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAL-MART STORES INC",
        "enumeration_date": "2006-08-27",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-16",
        "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": "NY",
            "license": "28015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2068219",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2860020",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAMS PHARMACY 10-6431",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elmira, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.

Verify at the official NPI Registry.