Provider Demographics
NPI:1518670595
Name:WEBSTER, SAMUEL ELLIOTT (PHARMD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ELLIOTT
Last Name:WEBSTER
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 1:17500 S 40TH STREET
Mailing Address - Street 2:BUILDING B SUITE B600A
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-4114
Mailing Address - Country:US
Mailing Address - Phone:480-688-2249
Mailing Address - Fax:901-201-5465
Practice Address - Street 1:17500 S 40TH STREET
Practice Address - Street 2:BUILDING B SUITE B600A
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226
Practice Address - Country:US
Practice Address - Phone:480-688-2249
Practice Address - Fax:901-201-5465
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist