=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740891316
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMER SULTAN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2020
-----------------------------------------------------
Last Update Date | 06/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2469 BAY AREA BLVD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77058-1519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-486-0613
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2727 NASA PKWY APT 209
-----------------------------------------------------
City | SEABROOK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77586-3238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-294-6379
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 90889
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 74863
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------