Healthcare Provider Details

I. General information

NPI: 1801077052
Provider Name (Legal Business Name): SAM Z CHAAR RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E BROADWAY
FULTON NY
13069-2300
US

IV. Provider business mailing address

8338 WARBLER WAY
LIVERPOOL NY
13090-1030
US

V. Phone/Fax

Practice location:
  • Phone: 315-598-2380
  • Fax: 315-598-3741
Mailing address:
  • Phone: 315-622-0785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number039208
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24503
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02990900
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14675
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43213
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: