Provider Demographics
NPI:1548093198
Name:MOLVI, SAMMI ADAM (PHARMACIST)
Entity type:Individual
Prefix:
First Name:SAMMI
Middle Name:ADAM
Last Name:MOLVI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4486 NW BOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3384
Mailing Address - Country:US
Mailing Address - Phone:541-360-1581
Mailing Address - Fax:
Practice Address - Street 1:150 LIBERTY ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3506
Practice Address - Country:US
Practice Address - Phone:033-643-3336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0008728183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist