Provider Demographics
NPI:1699111955
Name:ABOUD, SAMUEL MICHAEL JR (RPH)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:MICHAEL
Last Name:ABOUD
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S OCHOA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79901-2936
Mailing Address - Country:US
Mailing Address - Phone:915-545-7080
Mailing Address - Fax:915-545-7011
Practice Address - Street 1:700 S OCHOA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79901-2936
Practice Address - Country:US
Practice Address - Phone:915-545-7080
Practice Address - Fax:915-545-7011
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist