Provider Demographics
NPI:1447687967
Name:HUMPHREYS, SAMUEL SETH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:SETH
Last Name:HUMPHREYS
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 1:265 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-3126
Mailing Address - Country:US
Mailing Address - Phone:423-623-3456
Mailing Address - Fax:423-623-3049
Practice Address - Street 1:WILSON'S SAV-MOR DRUGS
Practice Address - Street 2:265 E MAIN STREET
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-3126
Practice Address - Country:US
Practice Address - Phone:423-623-3456
Practice Address - Fax:423-623-3049
Is Sole Proprietor?:No
Enumeration Date:2013-09-29
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN14970948OtherCAQH