MEDICARE: SAMIUL MIRZA

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	03446588	OH

General Provider Information

NPI Number	:	1376474411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMIUL MIRZA

Provider Business Mailing Address
First Line	:	308 HAMBRICK PARK
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30215-5268
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5644 MAYFIELD RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44124-2916
Country	:	US
Telephone Number	:	440-646-2314
Fax Number	:

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

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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Directions to “ SAMIUL MIRZA ” Practice Location

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