Provider Demographics
NPI:1053052001
Name:METHRATTA, SAM (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:SAM
Middle Name:
Last Name:METHRATTA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7031 COMAL DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3316
Mailing Address - Country:US
Mailing Address - Phone:781-738-0350
Mailing Address - Fax:
Practice Address - Street 1:711 DIRECTORS DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5103
Practice Address - Country:US
Practice Address - Phone:181-763-3668
Practice Address - Fax:817-633-6678
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist