MEDICARE: SAMANTHA SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	20034	AL

General Provider Information

NPI Number	:	1528625183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA SMITH

Provider Business Mailing Address
First Line	:	25 CHURCHHILL DR
Second Line	:
City	:	FORT MITCHELL
State	:	AL
Zip	:	36856-5612
Country	:	US
Telephone Number	:	928-277-6157
Fax Number	:

Provider Business Practice Location Address
First Line	:	3864 US HIGHWAY 80 W
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36870-6526
Country	:	US
Telephone Number	:	334-408-6068
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2019
Last Update Date	:	05/20/2019

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Directions to “ SAMANTHA SMITH ” Practice Location

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