Provider Demographics
NPI:1790055838
Name:MEKKAOUI, SAM A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:A
Last Name:MEKKAOUI
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 1:6806 ANCHORAGE LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-2567
Mailing Address - Country:US
Mailing Address - Phone:404-784-2420
Mailing Address - Fax:
Practice Address - Street 1:7636 MIDDLE VALLEY RD
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-2237
Practice Address - Country:US
Practice Address - Phone:423-242-0622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0295901835P0018X
TN405051835P0018X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist