Provider Demographics
NPI:1548579394
Name:SAMOJEDNY, JOSEPH MARTIN III (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MARTIN
Last Name:SAMOJEDNY
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:17900 23 MILE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-1161
Mailing Address - Country:US
Mailing Address - Phone:586-868-9053
Mailing Address - Fax:586-868-9055
Practice Address - Street 1:17900 23 MILE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-1161
Practice Address - Country:US
Practice Address - Phone:586-868-9053
Practice Address - Fax:586-868-9055
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5302024972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist