Provider Demographics
NPI:1487651907
Name:SAMARITAN MEDICAL CENTER PHARMACY
Entity Type:Organization
Organization Name:SAMARITAN MEDICAL CENTER PHARMACY
Other - Org Name:SAMARITAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:408-356-7111
Mailing Address - Street 1:2505 SAMARITAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4006
Mailing Address - Country:US
Mailing Address - Phone:408-356-7111
Mailing Address - Fax:408-358-6259
Practice Address - Street 1:2505 SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4006
Practice Address - Country:US
Practice Address - Phone:408-356-7111
Practice Address - Fax:408-358-6259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY33985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY33985OtherPHARMACY LICENCE NUMBER
CA05-23274OtherNABP NUMBER
CAPHY33985Medicaid
CA5553500001Medicare NSC