MEDICARE: SAMANTHA DODGE PHARM D

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	P7283	ID

General Provider Information

NPI Number	:	1952774481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA DODGE PHARM D

Provider Business Mailing Address
First Line	:	490 N 2ND E
Second Line	:
City	:	MOUNTAIN HOME
State	:	ID
Zip	:	83647-2729
Country	:	US
Telephone Number	:	208-587-3346
Fax Number	:

Provider Business Practice Location Address
First Line	:	490 N 2ND E
Second Line	:
City	:	MOUNTAIN HOME
State	:	ID
Zip	:	83647-2729
Country	:	US
Telephone Number	:	208-587-3346
Fax Number	:

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

Provider Enumeration Date	:	11/05/2015
Last Update Date	:	11/05/2015

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Directions to “ SAMANTHA DODGE PHARM D” Practice Location

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