Provider Demographics
NPI:1124206339
Name:FARIS, SAM LOUIS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:LOUIS
Last Name:FARIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 18TH ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-1242
Mailing Address - Country:US
Mailing Address - Phone:201-626-5533
Mailing Address - Fax:201-626-0288
Practice Address - Street 1:125 18TH ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-1242
Practice Address - Country:US
Practice Address - Phone:201-626-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02990000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist