Provider Demographics
NPI:1316981046
Name:SEM & SAM CORP
Entity type:Organization
Organization Name:SEM & SAM CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SABIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-938-1601
Mailing Address - Street 1:1071 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452
Mailing Address - Country:US
Mailing Address - Phone:718-410-9113
Mailing Address - Fax:718-410-9131
Practice Address - Street 1:1071 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-4601
Practice Address - Country:US
Practice Address - Phone:718-410-9113
Practice Address - Fax:718-410-9131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4855550001Medicare NSC