1194351437 NPI number — DR. SAMANTHA RUSSELL PHARMD

Table of content: DR. SAMANTHA RUSSELL PHARMD (NPI 1194351437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194351437 NPI number — DR. SAMANTHA RUSSELL PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUSSELL
Provider First Name:
SAMANTHA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FISCHER
Provider Other First Name:
SAMANTHA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194351437
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 GRAND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH AMBOY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08879-2144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-998-1730
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
979 ROUTE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08902-2712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-545-7979
Provider Business Practice Location Address Fax Number:
732-545-0616
Provider Enumeration Date:
03/18/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  28RI02792800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28RI03792800 . This is a "PHARMACIST REGISTRATION" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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