Healthcare Provider Details

I. General information

NPI: 1386743243
Provider Name (Legal Business Name): JIBRIL ABDUS-SAMAD PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRVING ST NW
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

9313 WIRE AVE
SILVER SPRING MD
20901-3436
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8000
  • Fax: 202-745-8639
Mailing address:
  • Phone: 215-868-5323
  • Fax: 202-745-8639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number16427
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: