Provider Demographics
NPI:1801506043
Name:MYERS, SAMUEL ANDREW (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ANDREW
Last Name:MYERS
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 1:302 LAKEWOOD HILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655
Mailing Address - Country:US
Mailing Address - Phone:662-352-4145
Mailing Address - Fax:
Practice Address - Street 1:653 CONCORDIA AVE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-1982
Practice Address - Country:US
Practice Address - Phone:662-638-6382
Practice Address - Fax:833-623-3054
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16903183500000X
MSE-11824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty