Provider Demographics
NPI:1750658266
Name:OSAFO, SAMUEL
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:OSAFO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3052 CHOCTAW RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-1822
Mailing Address - Country:US
Mailing Address - Phone:703-587-4343
Mailing Address - Fax:
Practice Address - Street 1:7940 RICHMOND HWY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-7826
Practice Address - Country:US
Practice Address - Phone:571-458-3510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist