Healthcare Provider Details

I. General information

NPI: 1932508371
Provider Name (Legal Business Name): PAUL JACOB SAMENUK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 ARLINGTON AVE
TOLEDO OH
43614-2595
US

IV. Provider business mailing address

3000 ARLINGTON AVE
TOLEDO OH
43614-2595
US

V. Phone/Fax

Practice location:
  • Phone: 419-383-4080
  • Fax:
Mailing address:
  • Phone: 419-383-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03213909
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: