Provider Demographics
NPI:1285173088
Name:GUERGUES, SAMY
Entity type:Individual
Prefix:
First Name:SAMY
Middle Name:
Last Name:GUERGUES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 US 1 HWY
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27596-8607
Mailing Address - Country:US
Mailing Address - Phone:919-554-1183
Mailing Address - Fax:
Practice Address - Street 1:1190 US 1 HWY
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27596-8607
Practice Address - Country:US
Practice Address - Phone:919-554-1183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist