Provider Demographics
NPI:1255614806
Name:BESHARA, SAMUEL (RPH, PHARM D, CCP)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:BESHARA
Suffix:
Gender:M
Credentials:RPH, PHARM D, CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PALISADES RD
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3585
Mailing Address - Country:US
Mailing Address - Phone:732-956-7535
Mailing Address - Fax:
Practice Address - Street 1:420 E 76TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3396
Practice Address - Country:US
Practice Address - Phone:212-434-5358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03454600183500000X
NY059008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist