Provider Demographics
NPI:1487937652
Name:SAMUELS, TOYA K (RPH)
Entity type:Individual
Prefix:MRS
First Name:TOYA
Middle Name:K
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ROSEMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-2925
Mailing Address - Country:US
Mailing Address - Phone:501-205-1951
Mailing Address - Fax:
Practice Address - Street 1:4823 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7314
Practice Address - Country:US
Practice Address - Phone:501-771-1971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN09699183500000X
ARPD10147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist