Provider Demographics
NPI:1083392781
Name:NYABAM, SAMUEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:NYABAM
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 1:11 S PACA ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1791
Mailing Address - Country:US
Mailing Address - Phone:410-328-5243
Mailing Address - Fax:
Practice Address - Street 1:11 S PACA ST STE 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1791
Practice Address - Country:US
Practice Address - Phone:410-328-5243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD272581835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care