Iminabo Samson Berepele

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

54617 Issued in TX

Practice address

3812 Gilmer Rd
Longview, TX 75604-1173

Phone

(903) 475-0477

Fax

(903) 475-0478

NPI assigned

Nov 23, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wal-Mart Stores Texas LLC

  dba Walmart Pharmacy 10-4114

  • Community/Retail Pharmacy
  • Longview, TX
  • NPI 1821404534
  NPD (past)
• Wal-Mart Stores Texas, LLC

  dba Walmart Pharmacy 10-1484

  • Community/Retail Pharmacy
  • Melissa, TX
  • NPI 1386521797
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606089600000",
    "number": "1023612744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3812 GILMER RD",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756041173",
            "telephone_number": "903-475-0477",
            "fax_number": "903-475-0478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3812 GILMER RD",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756041173",
            "telephone_number": "903-475-0477",
            "fax_number": "903-475-0478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEREPELE",
        "first_name": "IMINABO",
        "middle_name": "SAMSON",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-23",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "TX",
            "license": "54617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cinthia A Bennett, APN, FNP-BC
• Kendra Caroline Bennett, LPC - SUPERVISOR
• Jennifer Blair Garrett Benson, PA-C
• Adriana Bentley
• Joseph Byamugisha Beraho, M.D
• Elisa Lynn Berry, FNP
• George Albert Berry Jr., D.C.
• Jody David Berryhill, L.A.T.
• Bert E. Sharp, D.P.M., P.a.
• Bert E. Sharp, D.P.M., P.a.

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Longview, TX
• Providers in Longview, TX by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.