Healthcare Provider Details

I. General information

NPI: 1063872398
Provider Name (Legal Business Name): SAMUEL YIMAMU PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26020 POINT LOOKOUT RD
LEONARDTOWN MD
20650-2001
US

IV. Provider business mailing address

26020 POINT LOOKOUT RD
LEONARDTOWN MD
20650-2001
US

V. Phone/Fax

Practice location:
  • Phone: 301-475-8917
  • Fax: 301-997-0054
Mailing address:
  • Phone: 301-475-8917
  • Fax: 301-997-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23114
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: