MEDICARE: DR. EKIMA SAMPSON PHARMD

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	15864	OK
2	183500000X	Pharmacist	59609	TX

General Provider Information

NPI Number	:	1730690041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EKIMA SAMPSON PHARMD

Provider Business Mailing Address
First Line	:	7850 W GRAND PKWY S STE 600
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-5876
Country	:	US
Telephone Number	:	346-701-7188
Fax Number	:	346-867-2937

Provider Business Practice Location Address
First Line	:	7850 W GRAND PKWY S STE 600
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-5876
Country	:	US
Telephone Number	:	346-701-7188
Fax Number	:	346-867-2937

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

Provider Enumeration Date	:	10/13/2017
Last Update Date	:	04/11/2022

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