Healthcare Provider Details

I. General information

NPI: 1417812520
Provider Name (Legal Business Name): SAMY NABIL SADEEK GAD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 KEYSER AVE
NATCHITOCHES LA
71457-5802
US

IV. Provider business mailing address

300 KEYSER AVE
NATCHITOCHES LA
71457-5802
US

V. Phone/Fax

Practice location:
  • Phone: 318-357-0451
  • Fax:
Mailing address:
  • Phone: 318-357-0451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.026054
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: