Provider Demographics
NPI:1235841545
Name:GOOD SAMARITAN VENTURES LLC
Entity Type:Organization
Organization Name:GOOD SAMARITAN VENTURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:ABIEL
Authorized Official - Middle Name:HAILEAB
Authorized Official - Last Name:TSEGAI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:713-866-4021
Mailing Address - Street 1:3607 S MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5406
Mailing Address - Country:US
Mailing Address - Phone:713-866-4021
Mailing Address - Fax:713-866-6560
Practice Address - Street 1:3607 S MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5406
Practice Address - Country:US
Practice Address - Phone:713-866-4021
Practice Address - Fax:713-866-6560
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD SAMARITAN VENTURES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies