Provider Demographics
NPI:1972059715
Name:ROWEN, SAMANTHA TAYLOR
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:TAYLOR
Last Name:ROWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1102
Mailing Address - Country:US
Mailing Address - Phone:716-541-1994
Mailing Address - Fax:716-541-1996
Practice Address - Street 1:1010 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1102
Practice Address - Country:US
Practice Address - Phone:716-541-1994
Practice Address - Fax:716-541-1996
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist