Provider Demographics
NPI:1508996935
Name:SAMS RX DRUGS
Entity Type:Organization
Organization Name:SAMS RX DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:COBBIN
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:SR
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-896-6734
Mailing Address - Street 1:4765 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48210-1465
Mailing Address - Country:US
Mailing Address - Phone:313-896-6734
Mailing Address - Fax:313-896-1560
Practice Address - Street 1:4765 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-1465
Practice Address - Country:US
Practice Address - Phone:313-896-6734
Practice Address - Fax:313-896-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2516357Medicaid
MI2311974OtherNCPDP
MI5127110001Medicare ID - Type Unspecified