NPIMap

Organization Active NPI

Sams East Inc

Doing business as Sam's Club Pharmacy 10-7189

  • Pharmacy
  • Oklahoma City, OK
National Provider Identifier
1912364365
Registry record updated Jun 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
17521 Issued in OK
Legal business name
SAMS EAST INC
Doing business as
Sam's Club Pharmacy 10-7189
Sam's Pharmacy 10-7189
Practice address
4101 N May Ave
Oklahoma City, OK 73112-6239
Phone
(405) 200-0363
NPI assigned
Jan 15, 2016
Last updated
Jun 15, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2026

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)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X 17521 OK Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

4101 N May Ave
Oklahoma City, OK 73112-6239

Mailing address

1 Customer Dr
Mailstop 0445
Bentonville, AR 72716-0445

Other identifiers 2

IdentifierTypeStateIssuer
100246790MMedicaidOK
2157809OtherPK

Other names 2

  • Sam's Club Pharmacy 10-7189 Doing business as
  • Sam's Pharmacy 10-7189 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130731000252 OK Part B Supplier - Mass Immunization (Roster Biller Only) 7012038581 12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Oklahoma City, OK; Tulsa, OK; Norman, OK; Moore, OK; Lawton, OK
O20160425000782 OK DME Supplier - PharmacyDME Supplier - Optician 7012038581 Practice locations: Oklahoma City, OK

Other NPIs on the same Medicare enrollment 12

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

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
37D2126575Sam's Club Pharmacy 10-71894101 N May Ave, Oklahoma City, OK 73112Certificate of waiverFeb 28, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Sams Club Pharmacy 10-71894101 N May Ave, Oklahoma City, OK 73112-6239(405) 200-0363 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 Optical821 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 17

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

View all 17

Member of 2

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

  • Sams West Inc

    dba Sams Pharmacy 10-6254

    • Community/Retail Pharmacy
    • Maple Grove, MN
    • NPI 1184641581

    Member Of

    NPD member
  • Walmart Inc.

    dba Walmart Pharmacy 10-1588

    • Community/Retail Pharmacy
    • Victorville, CA
    • NPI 1043237456

    Member Of

    NPD member

Locations

4101 N May Ave
Oklahoma City, OK 73112
Phone (405) 200-0363

NPI Registry JSON

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

{
    "created_epoch": "1452816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781481600000",
    "number": "1912364365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CUSTOMER DR",
            "address_2": "MAILSTOP 0445",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 N MAY AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731126239",
            "telephone_number": "405-200-0363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMS EAST INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-15",
        "last_updated": "2026-06-15",
        "certification_date": "2026-06-15",
        "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": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "OK",
            "license": "17521",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100246790M",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2157809",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sam's Club Pharmacy 10-7189",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sam's Pharmacy 10-7189",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2026; 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.