Healthcare Provider Details

I. General information

NPI: 1043930076
Provider Name (Legal Business Name): SAMANTHA MELLINGER PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5914 HIGH ST W
PORTSMOUTH VA
23703-4506
US

IV. Provider business mailing address

117 SIGNATURE WAY APT 431
HAMPTON VA
23666-5956
US

V. Phone/Fax

Practice location:
  • Phone: 757-484-8400
  • Fax:
Mailing address:
  • Phone: 406-590-7679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202220744
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: