Healthcare Provider Details

I. General information

NPI: 1770410508
Provider Name (Legal Business Name): SAMANTHA AXELROD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11621 KEW GARDENS AVE STE 101A
PALM BEACH GARDENS FL
33410-2853
US

IV. Provider business mailing address

6047 UNGERER ST
JUPITER FL
33458-6607
US

V. Phone/Fax

Practice location:
  • Phone: 954-665-8090
  • Fax: 561-232-3074
Mailing address:
  • Phone: 954-665-8090
  • Fax: 561-232-3074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS62335
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: