Provider Demographics
NPI:1922122951
Name:SCUDERI, SAM (RPH)
Entity Type:Individual
Prefix:MR
First Name:SAM
Middle Name:
Last Name:SCUDERI
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 1:52 FAIRVIEW ST EXT
Mailing Address - Street 2:APT 12
Mailing Address - City:SOUTH GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12803-4883
Mailing Address - Country:US
Mailing Address - Phone:518-232-1220
Mailing Address - Fax:
Practice Address - Street 1:128 RIDGE ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3219
Practice Address - Country:US
Practice Address - Phone:518-792-0538
Practice Address - Fax:518-812-0305
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist