MEDICARE: SAM'S PHARMACY, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies	4412390001	TX
2	3336H0001X	Home Infusion Therapy Pharmacy	21010	TX
3	3336C0003X	Community/Retail Pharmacy	21010	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194745687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAM'S PHARMACY, INC.

Provider Business Mailing Address
First Line	:	8300 BISSONNET ST
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77074-3900
Country	:	US
Telephone Number	:	713-779-2100
Fax Number	:	713-779-3222

Provider Business Practice Location Address
First Line	:	8300 BISSONNET ST
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77074-3900
Country	:	US
Telephone Number	:	713-779-2100
Fax Number	:	713-779-3222

Authorized Official
Title or Position	:	CEO/PHARMACIST IN CHARGE
Name	:	DR. UCHEGBULEM ALOYSIUS EZE
Credential	:	PHARM.D
Telephone Number	:	713-779-2100

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	11/26/2012

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Directions to “SAM'S PHARMACY, INC. ” Practice Location

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