Provider Demographics
NPI:1376891382
Name:SIEGEL, SAMUEL SAUL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:SAUL
Last Name:SIEGEL
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 1:2401 SURREY DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2938
Mailing Address - Country:US
Mailing Address - Phone:304-685-8782
Mailing Address - Fax:
Practice Address - Street 1:300 N KANAWHA ST
Practice Address - Street 2:SUITE 207
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4736
Practice Address - Country:US
Practice Address - Phone:304-252-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist