Provider Demographics
NPI:1689410433
Name:ABDALLAH, SAMAH AMIN
Entity type:Individual
Prefix:
First Name:SAMAH
Middle Name:AMIN
Last Name:ABDALLAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BOARDMAN CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4007
Mailing Address - Country:US
Mailing Address - Phone:234-287-3010
Mailing Address - Fax:234-287-3040
Practice Address - Street 1:1400 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4007
Practice Address - Country:US
Practice Address - Phone:234-287-3010
Practice Address - Fax:234-287-3040
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03444350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist