Active NPI
Samantha Desimone
- Pharmacist
- Audubon, NJ
National Provider Identifier
1023611746
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 28RI03700700
- Practice address
- 130 Black Horse Pike
Audubon, NJ 08106-1960 - Phone
- (856) 310-1519
- NPI assigned
- Nov 17, 2020
- Last updated
- Nov 17, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 28RI03700700 | NJ | Primary |
Addresses
Primary practice location
130 Black Horse Pike
Audubon, NJ 08106-1960
Mailing address
206 Ferrell Rd
Mullica Hill, NJ 08062-4514
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI03700700 | NJ | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605571200000",
"number": "1023611746",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "206 FERRELL RD",
"city": "MULLICA HILL",
"state": "NJ",
"postal_code": "080624514"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 BLACK HORSE PIKE",
"city": "AUDUBON",
"state": "NJ",
"postal_code": "081061960",
"telephone_number": "856-310-1519"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESIMONE",
"first_name": "SAMANTHA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-17",
"last_updated": "2020-11-17",
"certification_date": "2020-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RI03700700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Audubon, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.