Healthcare Provider Details

I. General information

NPI: 1861308454
Provider Name (Legal Business Name): SAMIRA SAMARBAKHSH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL VILLAGE DR
EDGEWOOD KY
41017-3403
US

IV. Provider business mailing address

305 CAYTON RD APT 314
FLORENCE KY
41042-9490
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-4525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number025818
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: