Provider Demographics
NPI:1720361769
Name:SAMAAN, ANTHONY ELIAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ELIAS
Last Name:SAMAAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 FONTAINE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1868
Mailing Address - Country:US
Mailing Address - Phone:859-744-1377
Mailing Address - Fax:859-745-6599
Practice Address - Street 1:1041 FONTAINE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-1868
Practice Address - Country:US
Practice Address - Phone:859-553-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0011838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0011838Other0011838, KY PHARMACY LISCENCE #