Provider Demographics
NPI:1124433131
Name:CZIBUR, SAMANTHA (PHARMD)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:CZIBUR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9644 BOTHWELL LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7886
Mailing Address - Country:US
Mailing Address - Phone:215-622-6818
Mailing Address - Fax:
Practice Address - Street 1:7830 WORMANS MILL RD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-3034
Practice Address - Country:US
Practice Address - Phone:240-575-7345
Practice Address - Fax:240-575-7398
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARPI008607183500000X
PARP448718183500000X
MD22436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY061265OtherPHARMACIST LICENSE
MD22436OtherPHARMACIST AND VACCINATION LICENSE
PARPI008607OtherAUTHORIZATION TO ADMINSTER INJECTABLES
PARP448718OtherPHARMACIST LICENSE