Provider Demographics
NPI:1891026910
Name:JOSEPH, SAMUEL A (RPH)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:A
Last Name:JOSEPH
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 1:1483 DENVER AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4540
Mailing Address - Country:US
Mailing Address - Phone:631-968-5591
Mailing Address - Fax:
Practice Address - Street 1:300 BAY SHORE RD
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-2823
Practice Address - Country:US
Practice Address - Phone:631-586-8600
Practice Address - Fax:631-586-0039
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28499183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY303634433OtherDRIVER LICENSE