SAM'S CLUB PHARMACY
NPI 1487744678
Pharmacist in Bloomington, IN

Active since October 16, 2006CLIA 15D2136086 · Waiver
3205 W STATE ROAD 45, BLOOMINGTON, IN 47403(812) 333-8903(812) 333-8906 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Sam's Club Pharmacy NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAM'S CLUB PHARMACY (NPI 1487744678) is a healthcare organization registered as a pharmacist in Bloomington, Indiana and active in the NPI registry since October 2006. The organization holds a CLIA Waiver certificate valid through August 31, 2027 and lists Steven Michael Ridge, Phamacy Manager, as its authorized official.

NPPES Registry Identity

NPI1487744678
Entity TypeOrganization
Primary Taxonomy183500000X
Legal Business NameSAM'S CLUB PHARMACY
Location Address3205 W STATE ROAD 45Bloomington, IN 47403-5107
Mailing Address7463 N State Road 37Bloomington, IN 47404-9440 · (812) 876-4964
Fax(812) 333-8906
Organization SubpartNo
Authorized OfficialSteven Michael RidgePhamacy Manager · (812) 333-8903
Enumeration DateOctober 16, 2006
Last NPPES UpdateAugust 22, 2020
NPI 1487744678 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPharmacistPharmacy Service Providers
Taxonomy Code183500000X
License Licensed in IN · 26017690A
Definition

An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care.

3205 W STATE ROAD 45, Bloomington, IN 47403

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 15D2136086

Sam's Club Pharmacy 10-6437 · Bloomington, IN
Active · expires Aug 31, 2027
CLIA Number15D2136086
Laboratory TypePharmacy
Certificate Effective DateSeptember 1, 2025
Certificate Expiration DateAugust 31, 2027
Laboratory DirectorClayton Jenkins
Laboratory Phone(812) 333-8903
Laboratory LocationSam's Club Pharmacy 10-64373205 West State Hwy 45, Bloomington, IN 47403
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Medical Equipment Supplier

The provider carries the following medical supplies product categories:

PTAN
20513459
Accepts Medicare Assignment
NO
Specialities List
Pharmacy.
Competitive Bidding
NO

Supplies List

  • Epoetin - Epoetin is a man-made version of human erythropoietin (EPO)
  • Immunosuppressive Drugs - Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
  • Infusion Drugs -
  • Nebulizer Drugs - Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
  • Oral Anticancer Drugs - FDA anticancer drugs
  • Oral Antiemetic Drugs - FDA antiemetic drugs
  • Blood Glucose Monitors/Supplies (Non-Mail Order) - Home blood glucose monitors including lancets, reagent strips, and other supplies necessary for the proper functioning of the device
  • Blood Glucose Monitors/Supplies (Mail Order) - Home blood glucose monitors including lancets, reagent strips, and other supplies necessary for the proper functioning of the device
  • Ostomy Supplies - Pouches, Paste, Powder, Barrier wipes
  • Prosthetic Lenses: Conventional Eyeglasses - Conventional Eyeglasses
  • Enteral Nutrients - Enteral formula
  • Surgical Dressings - Gauze, Elastic bandages, Adhesive tape

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Optometrist
3205 W STATE ROAD 45
BLOOMINGTON, IN 47403
Optometrist
3205 W STATE ROAD 45
BLOOMINGTON, IN 47403
Pharmacist
3205 W STATE ROAD 45
BLOOMINGTON, IN 47403
Pharmacy (Community/Retail Pharmacy)
3205 W STATE ROAD 45
BLOOMINGTON, IN 47403
Eyewear Supplier
3205 W STATE ROAD 45
BLOOMINGTON, IN 47403

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1487744678, enumerated as an "organization" on October 16, 2006.

The provider is located at 3205 W STATE ROAD 45 BLOOMINGTON, IN 47403 and the phone number is (812) 333-8903.

Pharmacist with taxonomy code 183500000X.