Healthcare Provider Details

I. General information

NPI: 1275468365
Provider Name (Legal Business Name): SAMUEL ADJEI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 E RIVER VALLEY ST APT L302
MERIDIAN ID
83646-2358
US

IV. Provider business mailing address

3400 E RIVER VALLEY ST APT L302
MERIDIAN ID
83646-2358
US

V. Phone/Fax

Practice location:
  • Phone: 505-400-7067
  • Fax:
Mailing address:
  • Phone: 505-400-7067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number244116
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0330135975
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8771964
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: