Healthcare Provider Details

I. General information

NPI: 1205611860
Provider Name (Legal Business Name): SAMANTHA DENISE NICOLETTI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA DENISE MAMIE PHARMD

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 REETZ AVE
HULMEVILLE PA
19047-5881
US

IV. Provider business mailing address

770 REETZ AVE
HULMEVILLE PA
19047-5881
US

V. Phone/Fax

Practice location:
  • Phone: 215-470-0327
  • Fax:
Mailing address:
  • Phone: 215-470-0327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP457872
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: