Provider Demographics
NPI:1831994813
Name:TOMBOKAN, SAMUEL ANDREW (RPH)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ANDREW
Last Name:TOMBOKAN
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 1:209 VALLEY ST APT 508
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2877
Mailing Address - Country:US
Mailing Address - Phone:732-789-3341
Mailing Address - Fax:
Practice Address - Street 1:25 POCONO RD
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2954
Practice Address - Country:US
Practice Address - Phone:732-789-3341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04371000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist