Provider Demographics
NPI:1821135781
Name:ENDRESS, SAMUEL JACOB (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JACOB
Last Name:ENDRESS
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 1:5410 S LLOYD ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-1633
Mailing Address - Country:US
Mailing Address - Phone:509-879-6360
Mailing Address - Fax:
Practice Address - Street 1:5520 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1211
Practice Address - Country:US
Practice Address - Phone:509-489-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000649241835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy