Provider Demographics
NPI:1861145567
Name:LIOTTA, SAMANTHA TAYLOR (PHARMD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:TAYLOR
Last Name:LIOTTA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2142
Mailing Address - Country:US
Mailing Address - Phone:973-546-9599
Mailing Address - Fax:
Practice Address - Street 1:1646 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2142
Practice Address - Country:US
Practice Address - Phone:973-546-9599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04184600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist