Provider Demographics
NPI:1356625800
Name:OTTEY-SAMUELS, KARREN A (PHARMD)
Entity Type:Individual
Prefix:
First Name:KARREN
Middle Name:A
Last Name:OTTEY-SAMUELS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11635 ROBINSON ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7313
Mailing Address - Country:US
Mailing Address - Phone:305-255-8010
Mailing Address - Fax:
Practice Address - Street 1:16795 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-3441
Practice Address - Country:US
Practice Address - Phone:302-233-4786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist