Healthcare Provider Details

I. General information

NPI: 1861155103
Provider Name (Legal Business Name): SAMANTHA CHRISTINA BACARELLA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 COLUMBUS AVE
NEW YORK NY
10025-6461
US

IV. Provider business mailing address

15805 CRYDERS LN
WHITESTONE NY
11357-2704
US

V. Phone/Fax

Practice location:
  • Phone: 212-316-0436
  • Fax:
Mailing address:
  • Phone: 347-408-8512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number068387
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: