Provider Demographics
NPI:1568156891
Name:SAMUELS, RODNITA (PHARMD)
Entity Type:Individual
Prefix:
First Name:RODNITA
Middle Name:
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:RODNITA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:425 E 48TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-1401
Mailing Address - Country:US
Mailing Address - Phone:773-490-7906
Mailing Address - Fax:
Practice Address - Street 1:111 DEER LAKE RD STE 130
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4978
Practice Address - Country:US
Practice Address - Phone:855-422-7744
Practice Address - Fax:888-810-2014
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26026869A183500000X
IL051301106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist