Provider Demographics
NPI:1376241554
Name:SAITIE, SAMUEL MOORE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:MOORE
Last Name:SAITIE
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 1:331 SIJAN AVE
Mailing Address - Street 2:WHITEMAN AIR FORCE BASE
Mailing Address - City:KBOB NOSTER
Mailing Address - State:AA
Mailing Address - Zip Code:65336
Mailing Address - Country:US
Mailing Address - Phone:660-687-1774
Mailing Address - Fax:
Practice Address - Street 1:331 SIJEN AVE
Practice Address - Street 2:
Practice Address - City:WHITEMAN AIR FORCE BASE
Practice Address - State:MO
Practice Address - Zip Code:65305-1269
Practice Address - Country:US
Practice Address - Phone:660-687-2137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP457466333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy