MEDICARE: DR. SAMWEL LOTFY HANNA PHARMD

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	052867	NY
2	183500000X	Pharmacist	28RI03309100	NJ

General Provider Information

NPI Number	:	1528380680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMWEL LOTFY HANNA PHARMD

Provider Business Mailing Address
First Line	:	7510 13TH AVE FL 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2410
Country	:	US
Telephone Number	:	917-545-3681
Fax Number	:

Provider Business Practice Location Address
First Line	:	6823 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5856
Country	:	US
Telephone Number	:	718-745-0733
Fax Number	:

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

Provider Enumeration Date	:	02/17/2010
Last Update Date	:	02/17/2010

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