Individual
ANGELLA SAMSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1346 GRANVILLE PAYNE AVE, BROOKLYN, NY 11239-2103
(718) 642-2727
Mailing address
3320 AVENUE R, BROOKLYN, NY 11234-4434
(718) 866-5119
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
067200
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
067200
NYSED LICENSE NUMBER
NY
Enumeration date
10/08/2020
Last updated
10/08/2020
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