Provider Demographics
NPI:1104424704
Name:SAMAAN, JOSEPH (RPH)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:SAMAAN
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 1:602 ARTISAN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-4375
Mailing Address - Country:US
Mailing Address - Phone:210-992-5797
Mailing Address - Fax:
Practice Address - Street 1:5506 WALZEM RD
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78218-2103
Practice Address - Country:US
Practice Address - Phone:210-653-2360
Practice Address - Fax:210-653-0476
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist