Provider Demographics
NPI:1588831085
Name:SAMOYLOVICH, ANNA (RPH)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:SAMOYLOVICH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 NEPTUNE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-4004
Mailing Address - Country:US
Mailing Address - Phone:718-996-2233
Mailing Address - Fax:
Practice Address - Street 1:512 NEPTUNE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4004
Practice Address - Country:US
Practice Address - Phone:718-996-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist