Provider Demographics
NPI:1376144667
Name:PRICE, SAMUEL RICHARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:RICHARD
Last Name:PRICE
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 1:500 WARREN COUNTY CTR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-3023
Mailing Address - Country:US
Mailing Address - Phone:636-456-4243
Mailing Address - Fax:636-456-5500
Practice Address - Street 1:500 WARREN COUNTY CTR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-3023
Practice Address - Country:US
Practice Address - Phone:636-456-4243
Practice Address - Fax:636-456-5500
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012027071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist