Provider Demographics
NPI:1073785077
Name:SAMARA, MOHAMMAD A
Entity Type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:A
Last Name:SAMARA
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 1:296 FLATBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2812
Mailing Address - Country:US
Mailing Address - Phone:718-399-2716
Mailing Address - Fax:718-399-3225
Practice Address - Street 1:296 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2812
Practice Address - Country:US
Practice Address - Phone:718-399-2716
Practice Address - Fax:718-399-3225
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist