Provider Demographics
NPI:1841603800
Name:SAMUEL, SUNIL
Entity Type:Individual
Prefix:
First Name:SUNIL
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-3032
Mailing Address - Country:US
Mailing Address - Phone:215-335-4882
Mailing Address - Fax:215-335-2067
Practice Address - Street 1:6363 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-3032
Practice Address - Country:US
Practice Address - Phone:215-335-4882
Practice Address - Fax:215-335-2067
Is Sole Proprietor?:No
Enumeration Date:2014-06-08
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist