Provider Demographics
NPI:1336785658
Name:SAMY-TAWDROUS, SANDY LOTFY
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:LOTFY
Last Name:SAMY-TAWDROUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20891 E 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4530
Mailing Address - Country:US
Mailing Address - Phone:586-298-3855
Mailing Address - Fax:586-298-3857
Practice Address - Street 1:20891 E 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4530
Practice Address - Country:US
Practice Address - Phone:586-298-3855
Practice Address - Fax:586-298-3857
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020450811835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist