Individual
SAM THEYYAN NATHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS/PHARMACY
Contact information
Practice address
40955 MERCHANTS LN, LEONARDTOWN, MD 20650-3702
(301) 475-7212
Mailing address
2751 RED LION PL, WALDORF, MD 20602-2030
(301) 932-8079
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10756
MD
Other
Enumeration date
11/01/2006
Last updated
07/08/2007
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