Healthcare Provider Details

I. General information

NPI: 1710898390
Provider Name (Legal Business Name): SAMUEL GEORGE PRESTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 BROADWAY
EUREKA CA
95501-0134
US

IV. Provider business mailing address

621 HATHAWAY ST
MOSCOW ID
83843-9605
US

V. Phone/Fax

Practice location:
  • Phone: 170-744-1190
  • Fax:
Mailing address:
  • Phone: 208-310-2195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1981311
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number93067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: