Provider Demographics
NPI:1508477449
Name:SAMI, RITA
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:SAMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51200 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-1563
Mailing Address - Country:US
Mailing Address - Phone:586-716-3187
Mailing Address - Fax:586-716-3204
Practice Address - Street 1:51200 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-1563
Practice Address - Country:US
Practice Address - Phone:586-716-3187
Practice Address - Fax:586-716-3204
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI19308091138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist