Provider Demographics
NPI:1922607910
Name:SAMAAN, MARK M (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:M
Last Name:SAMAAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:587 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-3332
Mailing Address - Country:US
Mailing Address - Phone:973-376-0137
Mailing Address - Fax:
Practice Address - Street 1:587 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-3332
Practice Address - Country:US
Practice Address - Phone:973-376-0137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04127800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist