Provider Demographics
NPI:1326522541
Name:MONTGOMERY, SAMMIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SAMMIE
Middle Name:
Last Name:MONTGOMERY
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:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:GOLDTHWAITE
Mailing Address - State:TX
Mailing Address - Zip Code:76844-0389
Mailing Address - Country:US
Mailing Address - Phone:325-648-2484
Mailing Address - Fax:855-899-4147
Practice Address - Street 1:1503 W FRONT ST
Practice Address - Street 2:
Practice Address - City:GOLDTHWAITE
Practice Address - State:TX
Practice Address - Zip Code:76844-2056
Practice Address - Country:US
Practice Address - Phone:325-648-2484
Practice Address - Fax:855-899-4147
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist