Healthcare Provider Details

I. General information

NPI: 1851956981
Provider Name (Legal Business Name): SAMANTHA CHETOSKY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MIAMI VALLEY DR STE 1000
CENTERVILLE OH
45459-4774
US

IV. Provider business mailing address

1 WYOMING ST
DAYTON OH
45409-2711
US

V. Phone/Fax

Practice location:
  • Phone: 937-438-8308
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03445953
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number0202210819
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: