Healthcare Provider Details

I. General information

NPI: 1609538370
Provider Name (Legal Business Name): NOELLA BUWAH SAMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 MAIN ST
CHESTER MD
21619-2604
US

IV. Provider business mailing address

2612 SWANN WING CT
GLENARDEN MD
20706-1682
US

V. Phone/Fax

Practice location:
  • Phone: 410-643-5119
  • Fax:
Mailing address:
  • Phone: 443-572-1737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28250
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: