Provider Demographics
NPI:1336353846
Name:SAMUEL, JUDITH (RPH,PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:RPH,PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 AVE TITO CASTRO
Mailing Address - Street 2:SUITE 102 PMB 201
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0200
Mailing Address - Country:US
Mailing Address - Phone:787-460-6939
Mailing Address - Fax:787-651-5559
Practice Address - Street 1:2431 AVE LAS AMERICAS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2113
Practice Address - Country:US
Practice Address - Phone:787-651-5557
Practice Address - Fax:787-651-5559
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist