Provider Demographics
NPI:1336837350
Name:BROWN-SAMUELS, KIYAH
Entity Type:Individual
Prefix:
First Name:KIYAH
Middle Name:
Last Name:BROWN-SAMUELS
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 1:2911 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-3073
Mailing Address - Country:US
Mailing Address - Phone:215-688-8349
Mailing Address - Fax:
Practice Address - Street 1:6101 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-1931
Practice Address - Country:US
Practice Address - Phone:215-924-9645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician