Provider Demographics
NPI:1336607795
Name:SAMAREX LLC
Entity Type:Organization
Organization Name:SAMAREX LLC
Other - Org Name:RYSA PHARMACY 101
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERSEDE
Authorized Official - Middle Name:
Authorized Official - Last Name:RANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-209-4067
Mailing Address - Street 1:19095 RAVENSWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-9040
Mailing Address - Country:US
Mailing Address - Phone:408-209-4067
Mailing Address - Fax:
Practice Address - Street 1:620 BROADWAY ST STE P
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-3200
Practice Address - Country:US
Practice Address - Phone:831-204-6020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy