MEDICARE: SARAH SAMUEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	071466	NY

General Provider Information

NPI Number	:	1730923962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH SAMUEL

Provider Business Mailing Address
First Line	:	11 CHADWICK RD
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-6508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22036 HILLSIDE AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11427-2020
Country	:	US
Telephone Number	:	718-264-2222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2024
Last Update Date	:	06/22/2024

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Directions to “ SARAH SAMUEL ” Practice Location

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