Provider Demographics
NPI:1568834604
Name:SAMA, SATYANARAYANA
Entity Type:Individual
Prefix:
First Name:SATYANARAYANA
Middle Name:
Last Name:SAMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3122 CINDY DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5126
Mailing Address - Country:US
Mailing Address - Phone:302-357-1945
Mailing Address - Fax:
Practice Address - Street 1:620 STANTON CHRISTIANA RD STE 102
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2134
Practice Address - Country:US
Practice Address - Phone:302-407-5895
Practice Address - Fax:302-407-3560
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0004259183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist