MEDICARE: OLANI SAMUEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03226648	OH

General Provider Information

NPI Number	:	1528662673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLANI SAMUEL

Provider Business Mailing Address
First Line	:	5345 FORT WARD DR
Second Line	:
City	:	NEW ALBANY
State	:	OH
Zip	:	43054-7114
Country	:	US
Telephone Number	:	614-917-8873
Fax Number	:	614-656-8252

Provider Business Practice Location Address
First Line	:	175 W MAIN ST
Second Line	:
City	:	NEW ALBANY
State	:	OH
Zip	:	43054-9227
Country	:	US
Telephone Number	:	614-855-5771
Fax Number	:	614-933-0434

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2020
Last Update Date	:	11/29/2020

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Directions to “ OLANI SAMUEL ” Practice Location

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