Provider Demographics
NPI:1467629352
Name:GHATAS, SAMY (RPH)
Entity Type:Individual
Prefix:MR
First Name:SAMY
Middle Name:
Last Name:GHATAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 N GEORGE STREET EXT
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:17345-9208
Mailing Address - Country:US
Mailing Address - Phone:717-266-6609
Mailing Address - Fax:717-268-8329
Practice Address - Street 1:4135 N GEORGE STREET EXT
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:PA
Practice Address - Zip Code:17345-9208
Practice Address - Country:US
Practice Address - Phone:717-266-6609
Practice Address - Fax:717-268-8329
Is Sole Proprietor?:No
Enumeration Date:2008-05-10
Last Update Date:2008-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist