Healthcare Provider Details

I. General information

NPI: 1821135781
Provider Name (Legal Business Name): SAMUEL JACOB ENDRESS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 N DIVISION ST
SPOKANE WA
99208-1211
US

IV. Provider business mailing address

5410 S LLOYD ST
SPOKANE WA
99223-1633
US

V. Phone/Fax

Practice location:
  • Phone: 509-489-6010
  • Fax:
Mailing address:
  • Phone: 509-879-6360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPH00064924
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: