Provider Demographics
NPI:1023290053
Name:STORICKS, SAMUEL A SR (LPN)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:A
Last Name:STORICKS
Suffix:SR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08098-1201
Mailing Address - Country:US
Mailing Address - Phone:856-769-0719
Mailing Address - Fax:
Practice Address - Street 1:19 AUBURN ST
Practice Address - Street 2:
Practice Address - City:WOODSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08098-1201
Practice Address - Country:US
Practice Address - Phone:856-769-0719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL2-0008498164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse