Healthcare Provider Details

I. General information

NPI: 1275983165
Provider Name (Legal Business Name): SAMIA AZIZ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 MOUNTAIN AVE
HACKETTSTOWN NJ
07840-2408
US

IV. Provider business mailing address

17 LAURIE TER
HACKETTSTOWN NJ
07840-2507
US

V. Phone/Fax

Practice location:
  • Phone: 908-852-2223
  • Fax:
Mailing address:
  • Phone: 908-798-8715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03717100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: