Provider Demographics
NPI:1598199705
Name:KIRATU, SAMUEL NG'ANG'A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:NG'ANG'A
Last Name:KIRATU
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 1:4411 KINSEY DR
Mailing Address - Street 2:APT#836
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4411 KINSEY DR
Practice Address - Street 2:APT#836
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1015
Practice Address - Country:US
Practice Address - Phone:978-360-6595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist