Provider Demographics
NPI:1144467267
Name:TALATI, SAMIR (RPH)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:
Last Name:TALATI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:SAMIRKUMAR
Other - Middle Name:
Other - Last Name:TALATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 FABISZEWSKI WAY
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-1684
Mailing Address - Country:US
Mailing Address - Phone:848-260-7250
Mailing Address - Fax:
Practice Address - Street 1:10 FABISZEWSKI WAY
Practice Address - Street 2:
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859
Practice Address - Country:US
Practice Address - Phone:848-260-7250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY055367OtherPHARMACIST LICENSE