Provider Demographics
NPI:1558233965
Name:AWADA, SAMUEL (RPH)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:AWADA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23290 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-4260
Mailing Address - Country:US
Mailing Address - Phone:586-772-6872
Mailing Address - Fax:586-772-6873
Practice Address - Street 1:23290 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-4260
Practice Address - Country:US
Practice Address - Phone:586-772-6872
Practice Address - Fax:586-772-6873
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist