Provider Demographics
NPI:1457674848
Name:SAMUELS, DELROSE
Entity Type:Individual
Prefix:MS
First Name:DELROSE
Middle Name:
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-2723
Mailing Address - Country:US
Mailing Address - Phone:191-473-8240
Mailing Address - Fax:191-473-8690
Practice Address - Street 1:661 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-2723
Practice Address - Country:US
Practice Address - Phone:191-473-8240
Practice Address - Fax:191-473-8690
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035711183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy