Healthcare Provider Details

I. General information

NPI: 1346994803
Provider Name (Legal Business Name): SAMUEL MAAIAH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1471 S HAVANA ST
AURORA CO
80012-4013
US

IV. Provider business mailing address

898 S KALISPELL CIR UNIT 102
AURORA CO
80017-2080
US

V. Phone/Fax

Practice location:
  • Phone: 303-750-6405
  • Fax:
Mailing address:
  • Phone: 402-905-1573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0023637
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: