Provider Demographics
NPI:1609538370
Name:SAMA, NOELLA BUWAH
Entity Type:Individual
Prefix:
First Name:NOELLA
Middle Name:BUWAH
Last Name:SAMA
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 1:2612 SWANN WING CT
Mailing Address - Street 2:
Mailing Address - City:GLENARDEN
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1682
Mailing Address - Country:US
Mailing Address - Phone:443-572-1737
Mailing Address - Fax:
Practice Address - Street 1:1802 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MD
Practice Address - Zip Code:21619-2604
Practice Address - Country:US
Practice Address - Phone:410-643-5119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist