Provider Demographics
NPI:1962770099
Name:KOLEILAT, SAMER (RPH)
Entity type:Individual
Prefix:
First Name:SAMER
Middle Name:
Last Name:KOLEILAT
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 1:2500 E LAS OLAS BLVD
Mailing Address - Street 2:APT 1009
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1508
Mailing Address - Country:US
Mailing Address - Phone:954-463-0613
Mailing Address - Fax:
Practice Address - Street 1:3101 N OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7115
Practice Address - Country:US
Practice Address - Phone:954-564-8424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-04
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist