Provider Demographics
NPI:1538481494
Name:GIRGIS, SAMIR A (RPH)
Entity Type:Individual
Prefix:MR
First Name:SAMIR
Middle Name:A
Last Name:GIRGIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-3854
Mailing Address - Country:US
Mailing Address - Phone:585-746-4169
Mailing Address - Fax:
Practice Address - Street 1:701 WELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-1602
Practice Address - Country:US
Practice Address - Phone:631-225-2528
Practice Address - Fax:631-225-3413
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist