Provider Demographics
NPI:1831708908
Name:SAMALA, KATHRYN ISRAEL (PHARMD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ISRAEL
Last Name:SAMALA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ANNE
Other - Last Name:ISRAEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:22341 SHORESIDE DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-6611
Mailing Address - Country:US
Mailing Address - Phone:352-339-3087
Mailing Address - Fax:
Practice Address - Street 1:11110 CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-2900
Practice Address - Country:US
Practice Address - Phone:813-661-4816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPH13690183500000X
FLPS50101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist