Healthcare Provider Details

I. General information

NPI: 1689493157
Provider Name (Legal Business Name): SAMMY DAAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

8051 33RD AVE S UNIT 638
BLOOMINGTON MN
55425-5018
US

V. Phone/Fax

Practice location:
  • Phone: 803-741-4611
  • Fax:
Mailing address:
  • Phone: 803-741-4611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number74856
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: