Healthcare Provider Details

I. General information

NPI: 1952184400
Provider Name (Legal Business Name): JOSEPH SAMADI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N US HIGHWAY 1
TEQUESTA FL
33469-2372
US

IV. Provider business mailing address

512 MARLIN RD
NORTH PALM BEACH FL
33408-4324
US

V. Phone/Fax

Practice location:
  • Phone: 561-741-8530
  • Fax:
Mailing address:
  • Phone: 561-933-2478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS66151
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: