MEDICARE: MS. SAMAR KANDALAFT PHARMACIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302038841	MI

General Provider Information

NPI Number	:	1104175199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SAMAR KANDALAFT PHARMACIST

Provider Business Mailing Address
First Line	:	2011 S ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-3857
Country	:	US
Telephone Number	:	248-844-2559
Fax Number	:

Provider Business Practice Location Address
First Line	:	2011 S ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-3857
Country	:	US
Telephone Number	:	248-844-2559
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2012
Last Update Date	:	07/22/2020

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