Healthcare Provider Details

I. General information

NPI: 1235675703
Provider Name (Legal Business Name): SAMUEL HULSEY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8035 E BROWN RD BLDG 4, SUITE-C
MESA AZ
85207-3901
US

IV. Provider business mailing address

8035 E BROWN RD BLDG 4, SUITE-C
MESA AZ
85207-3901
US

V. Phone/Fax

Practice location:
  • Phone: 480-565-7222
  • Fax: 480-499-0396
Mailing address:
  • Phone: 480-565-7222
  • Fax: 480-499-0396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS021971
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: