Organization
SAMUEL D EVANG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL DESIRE EVANG PHARMD (PHARMACIST IN CHARGE)
(972) 442-4277
Entity
Organization
Contact information
Practice address
615 TX-78 SUITE 200, WYLIE, TX 75098-4101
(972) 442-4277
Mailing address
615 TX-78, SUITE 200, WYLIE, TX 75098-4101
(972) 442-4277
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
31091
TX
3336C0004X
Compounding Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2166828
PK
—
Enumeration date
11/07/2016
Last updated
04/23/2020
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