Provider Demographics
NPI:1194351437
Name:RUSSELL, SAMANTHA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:14 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2144
Mailing Address - Country:US
Mailing Address - Phone:973-998-1730
Mailing Address - Fax:
Practice Address - Street 1:979 ROUTE 1
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-2712
Practice Address - Country:US
Practice Address - Phone:732-545-7979
Practice Address - Fax:732-545-0616
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02792800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03792800OtherPHARMACIST REGISTRATION