Provider Demographics
NPI:1790258481
Name:AMER, SAM N (RPH)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:N
Last Name:AMER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:SAMER
Other - Middle Name:N
Other - Last Name:AMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5531
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-0531
Mailing Address - Country:US
Mailing Address - Phone:313-247-5629
Mailing Address - Fax:
Practice Address - Street 1:29555 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2125
Practice Address - Country:US
Practice Address - Phone:313-247-5629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-06
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000OtherN/A