Provider Demographics
NPI:1467887760
Name:NASS, SAMUEL (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:NASS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 VALENCIA DR
Mailing Address - Street 2:207
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7057
Mailing Address - Country:US
Mailing Address - Phone:312-623-6277
Mailing Address - Fax:
Practice Address - Street 1:1711 W CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1517
Practice Address - Country:US
Practice Address - Phone:847-577-7099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051,297019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist