Healthcare Provider Details

I. General information

NPI: 1669837563
Provider Name (Legal Business Name): SAMSAK PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2015
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 E 180TH ST
BRONX NY
10460-1916
US

IV. Provider business mailing address

906 E 180TH ST
BRONX NY
10460-1916
US

V. Phone/Fax

Practice location:
  • Phone: 718-450-8759
  • Fax: 718-450-8890
Mailing address:
  • Phone: 718-450-8759
  • Fax: 718-450-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number034349
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROHIT SAKARIA
Title or Position: PHARMACIST
Credential:
Phone: 718-450-8759