Healthcare Provider Details

I. General information

NPI: 1962725366
Provider Name (Legal Business Name): SAM PAPASAVAS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BOULEVARD
HASBROUCK HEIGHTS NJ
07604-1518
US

IV. Provider business mailing address

450 BOULEVARD
HASBROUCK HEIGHTS NJ
07604-1518
US

V. Phone/Fax

Practice location:
  • Phone: 201-288-0404
  • Fax: 201-288-1631
Mailing address:
  • Phone: 201-288-0404
  • Fax: 201-288-1631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI2557700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: