Healthcare Provider Details

I. General information

NPI: 1518204882
Provider Name (Legal Business Name): SAMARA PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7855 ARGYLE FOREST BLVD STE 801
JACKSONVILLE FL
32244-7706
US

IV. Provider business mailing address

7855 ARGYLE FOREST BLVD STE 801
JACKSONVILLE FL
32244-7706
US

V. Phone/Fax

Practice location:
  • Phone: 904-800-1888
  • Fax: 904-619-1129
Mailing address:
  • Phone: 904-800-1888
  • Fax: 904-619-1129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26364
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SATISH BADDAM
Title or Position: PHARMACY MANAGER
Credential:
Phone: 904-800-1888