Healthcare Provider Details

I. General information

NPI: 1790325009
Provider Name (Legal Business Name): SAMANTHA BEERY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 CROWN PLAZA DR
COLUMBUS OH
43235-7310
US

IV. Provider business mailing address

3965 KUL CIR N
HILLIARD OH
43026-4822
US

V. Phone/Fax

Practice location:
  • Phone: 614-326-5650
  • Fax: 614-340-1077
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03439080
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: