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General NPI Number Information
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NPI Number | 1063017044
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Entity Type | Individual
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Provider Name | SAMSON YU
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Gender | Male
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 1575 BLUE HILL AVE
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City | MATTAPAN
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State | MA
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Zip | 02126-2122
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Country | US
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Telephone | 617-898-1282
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Fax | 617-898-1287
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Provider Business Mailing Address
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Address Line | 27 LOWE ST
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City | QUINCY
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State | MA
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Zip | 02169-6919
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Country | US
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Telephone | 617-669-0374
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH237660
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License Number State | MA
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