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General NPI Number Information
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NPI Number | 1841916723
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Entity Type | Individual
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Provider Name | EDWIN SAMA TITA PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 10/13/2022
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 10611 S SAM HOUSTON PKWY W STE 200
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City | HOUSTON
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State | TX
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Zip | 77071-3111
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Country | US
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Telephone | 713-667-4010
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Fax | 713-667-9304
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Provider Business Mailing Address
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Address Line | PO BOX 809160
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City | CHICAGO
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State | IL
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Zip | 60680-9160
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Country | US
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Telephone | 480-765-5043
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 32748
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License Number State | TX
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