Healthcare Provider Details

I. General information

NPI: 1356786024
Provider Name (Legal Business Name): SAMAR AND RANYA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69045 M 62 STE G
EDWARDSBURG MI
49112-9152
US

IV. Provider business mailing address

69045 M 62 STE G
EDWARDSBURG MI
49112-9152
US

V. Phone/Fax

Practice location:
  • Phone: 269-414-4554
  • Fax: 269-414-4558
Mailing address:
  • Phone: 269-414-4554
  • Fax: 269-414-4558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301010092
License Number StateMI

VIII. Authorized Official

Name: RANYA KADI
Title or Position: OWNER, PIC, AO
Credential: RPH
Phone: 269-414-4554