Provider Demographics
NPI:1194152835
Name:OGBUCHI-SANTANA, SAMPSON NNADI JR (PHARM D)
Entity type:Individual
Prefix:DR
First Name:SAMPSON
Middle Name:NNADI
Last Name:OGBUCHI-SANTANA
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5512 GREENWOOD CREEK DR APT 428
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3992
Mailing Address - Country:US
Mailing Address - Phone:504-729-7075
Mailing Address - Fax:
Practice Address - Street 1:6205 WESTCREEK DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-4319
Practice Address - Country:US
Practice Address - Phone:817-263-0962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52810183500000X
LA020069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist