Provider Demographics
NPI:1609957935
Name:SAMS-Y-INC
Entity Type:Organization
Organization Name:SAMS-Y-INC
Other - Org Name:SAMS DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:YAGODA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-493-1400
Mailing Address - Street 1:14200 FENKELL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-3217
Mailing Address - Country:US
Mailing Address - Phone:313-493-1400
Mailing Address - Fax:313-493-1633
Practice Address - Street 1:14200 FENKELL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-3217
Practice Address - Country:US
Practice Address - Phone:313-493-1400
Practice Address - Fax:313-493-1633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2516320Medicaid
MI4689910001Medicare NSC