1. Home
  2. Directory
  3. Indiana
  4. Bloomington
  5. Pharmacist
  6. NPI Profile

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: August 16, 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
Phone(812) 333-8903
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
Open in Google Maps ↗

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 Medicare DMEPOS 12

Medicare supplier enrollment and the product categories Sam's Club Pharmacy #10-6437 carries, from the Medicare DMEPOS supplier directory.

Sam's Club Pharmacy #10-6437

DMEPOS supplier · Bloomington, INOperated by Sam's East, Inc.
⋮

Does not accept Medicare assignment

Sam's Club Pharmacy #10-6437 has not agreed to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients may be charged more than the Medicare-approved amount; confirm the expected cost with the supplier before ordering.

PTAN (Medicare Supplier Number)20513459
Medicare Participant SinceMay 15, 2013
Supplier Location3205 W State Rd 45Bloomington, IN 47403
Phone(812) 333-8903
Supplier Specialties
Pharmacy

Medicare Product Categories

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
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Other Providers at the Same Location NPPES 6

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

CHRISTENSEN EYE CARE LLC
Optometrist
3205 W STATE ROAD 45
BLOOMINGTON, IN 47403
Monroe County (812) 333-8912
SAMS EAST INC
Pharmacy (Community/Retail Pharmacy)
3205 W STATE ROAD 45
BLOOMINGTON, IN 47403
Monroe County (812) 333-8903
I-CARE BLOOMINGTON INC
Optometrist
3205 W STATE ROAD 45
BLOOMINGTON, IN 47403
Monroe County (812) 333-8912
MS. LIBBY YOUNGER BC-HIS
Hearing Instrument Specialist
3205 W STATE ROAD 45
BLOOMINGTON, IN 47403
Monroe County (812) 558-7391
SAM'S CLUB OPTICAL
Eyewear Supplier
3205 W STATE ROAD 45
BLOOMINGTON, IN 47403
Monroe County (812) 331-0003
DAVID WINTCZAK
Pharmacist
3205 W STATE ROAD 45
BLOOMINGTON, IN 47403
Monroe County (812) 333-8903

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sam's Club Pharmacy's NPI number?

The NPI number for Sam's Club Pharmacy is 1487744678. It was assigned to this organization in the NPPES registry on October 16, 2006.

Where is Sam's Club Pharmacy located?

Sam's Club Pharmacy is located at 3205 W State Road 45, Bloomington, IN 47403. The listed phone number is (812) 333-8903.

What is Sam's Club Pharmacy's specialty?

The primary specialty registered for this NPI is Pharmacist with taxonomy code 183500000X.

Does Sam's Club Pharmacy accept Medicare assignment for medical equipment?

No. As a Medicare medical equipment supplier, Sam's Club Pharmacy #10-6437 does not accept Medicare assignment for equipment and supplies, so patients may be charged more than the Medicare-approved amount. Confirm the expected cost with the supplier before ordering.

Does Sam's Club Pharmacy hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 15D2136086) is associated with this NPI, valid through August 31, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Sam's Club Pharmacy was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.