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General NPI Number Information
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NPI Number | 1902129844
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Entity Type | Individual
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Provider Name | SAMUEL MANEEN R.PH.
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Gender | Male
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Dates
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Enumeration Date | 03/07/2010
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Last Update Date | 03/07/2010
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Provider Practice Location Address
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Address Line | 8378 SENECA TPKE
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City | NEW HARTFORD
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State | NY
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Zip | 13413-4956
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Country | US
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Telephone | 315-724-4455
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Fax |
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Provider Business Mailing Address
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Address Line | 176 W STATE ST
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City | ILION
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State | NY
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Zip | 13357-1518
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Country | US
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Telephone | 980-297-4364
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 043317
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License Number State | NY
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