Active NPI
Jordan T Samorajski
- Pharmacist
- New Berlin, WI
National Provider Identifier
1053036343
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 21469
- Practice address
- 13775 W Crawford Dr
New Berlin, WI 53151-5311 - Phone
- (414) 335-7365
- NPI assigned
- Oct 10, 2022
- Sex
- Male
- 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 | 21469 | WI | Primary |
Addresses
Primary practice location
13775 W Crawford Dr
New Berlin, WI 53151-5311
Mailing address
13775 W Crawford Dr
New Berlin, WI 53151-5311
Phone (414) 335-7365
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 |
|---|---|---|---|
| 21469 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1665360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693699200000",
"number": "1053036343",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13775 W CRAWFORD DR",
"city": "NEW BERLIN",
"state": "WI",
"postal_code": "531515311",
"telephone_number": "414-335-7365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13775 W CRAWFORD DR",
"city": "NEW BERLIN",
"state": "WI",
"postal_code": "531515311",
"telephone_number": "414-335-7365"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMORAJSKI",
"first_name": "JORDAN",
"middle_name": "T",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-10-10",
"last_updated": "2023-09-03",
"certification_date": "2023-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "21469",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Berlin, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.