Samson Angole
Individual provider Active NPI Pharmacist · Corinth, TX
NPI 1063016129 · NPPES record last updated Nov 29, 2020
Key facts
- NPI
- 1063016129
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 54031 (TX)
- Practice address
- 1101 FM 2181
Corinth, TX 76210-2136 - Phone
- (940) 497-1105
- NPI assigned
- Nov 29, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54031 | TX | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Pharmacy Inc | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 54031 | TX | Yes |
Addresses
Primary practice location
1101 FM 2181
Corinth, TX 76210-2136
Mailing address
1101 FM 2181
Corinth, TX 76210-2136
Phone (940) 497-1105
Other providers in Corinth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.