Provider Demographics
NPI:1740891316
Name:SULTAN, SAMER
Entity type:Individual
Prefix:
First Name:SAMER
Middle Name:
Last Name:SULTAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 NASA PKWY APT 209
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-3238
Mailing Address - Country:US
Mailing Address - Phone:818-294-6379
Mailing Address - Fax:
Practice Address - Street 1:2469 BAY AREA BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-1519
Practice Address - Country:US
Practice Address - Phone:281-486-0613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-16
Last Update Date:2025-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90889183500000X
TX74863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist