Active NPI
Rency Samuel
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Grand Prairie, TX
National Provider Identifier
1902406002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- 41748
- Practice address
- 2525 W Interstate 20
Grand Prairie, TX 75052-3929 - Phone
- (972) 988-1366
- Fax
- (972) 988-6641
- NPI assigned
- Oct 28, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 41748 | TX | Primary |
Addresses
Primary practice location
2525 W Interstate 20
Grand Prairie, TX 75052-3929
Mailing address
2525 W Interstate 20
Grand Prairie, TX 75052-3929
Phone (972) 988-1366
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41748 | TX | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kroger Texas LP | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Retail Pharmacy
- Fort Worth, TX
- NPI 1407747439
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603843200000",
"number": "1902406002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2525 W INTERSTATE 20",
"city": "GRAND PRAIRIE",
"state": "TX",
"postal_code": "750523929",
"telephone_number": "972-988-1366",
"fax_number": "972-988-6641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2525 W INTERSTATE 20",
"city": "GRAND PRAIRIE",
"state": "TX",
"postal_code": "750523929",
"telephone_number": "972-988-1366",
"fax_number": "972-988-6641"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMUEL",
"first_name": "RENCY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-28",
"last_updated": "2020-10-28",
"certification_date": "2020-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "TX",
"license": "41748",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Prairie, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 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.