MEDICARE: MR. SAMUEL SAGWE ONCHIRI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	63523	TX

General Provider Information

NPI Number	:	1063056042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAMUEL SAGWE ONCHIRI

Provider Business Mailing Address
First Line	:	1939 CASTAWAY DR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75051-3448
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 AIRBASE RD
Second Line	:
City	:	POLLOCK
State	:	LA
Zip	:	71467-0000
Country	:	US
Telephone Number	:	318-765-4717
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2019
Last Update Date	:	11/01/2019

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Directions to “ MR. SAMUEL SAGWE ONCHIRI ” Practice Location

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