Provider Demographics
NPI:1215392410
Name:SAMAROU, FARIDATOU (PHARMD)
Entity type:Individual
Prefix:
First Name:FARIDATOU
Middle Name:
Last Name:SAMAROU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-0331
Mailing Address - Country:US
Mailing Address - Phone:801-609-1212
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 331
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-0331
Practice Address - Country:US
Practice Address - Phone:801-609-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7106768-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist