Provider Demographics
NPI:1336338813
Name:SAMMA LLC
Entity Type:Organization
Organization Name:SAMMA LLC
Other - Org Name:MARTHA FARMACIA & DISCOUNT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-823-7887
Mailing Address - Street 1:6871 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5337
Mailing Address - Country:US
Mailing Address - Phone:305-823-7887
Mailing Address - Fax:305-823-7998
Practice Address - Street 1:6871 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-5337
Practice Address - Country:US
Practice Address - Phone:305-823-7887
Practice Address - Fax:305-823-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH229343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2010007OtherPK
FL008102600Medicaid
FL008102600Medicaid