Provider Demographics
NPI:1356786024
Name:SAMAR AND RANYA INC
Entity type:Organization
Organization Name:SAMAR AND RANYA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:RANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KADI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:269-414-4554
Mailing Address - Street 1:69045 M 62 STE G
Mailing Address - Street 2:
Mailing Address - City:EDWARDSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49112-9152
Mailing Address - Country:US
Mailing Address - Phone:269-414-4554
Mailing Address - Fax:269-414-4558
Practice Address - Street 1:69045 M 62 STE G
Practice Address - Street 2:
Practice Address - City:EDWARDSBURG
Practice Address - State:MI
Practice Address - Zip Code:49112-9152
Practice Address - Country:US
Practice Address - Phone:269-414-4554
Practice Address - Fax:269-414-4558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010100923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140298OtherPK