Healthcare Provider Details

I. General information

NPI: 1508690025
Provider Name (Legal Business Name): SAMANTHA YEAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA WHITE

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 SE WYOMING BLVD
CASPER WY
82609-1906
US

IV. Provider business mailing address

190 SE WYOMING BLVD
CASPER WY
82609-1906
US

V. Phone/Fax

Practice location:
  • Phone: 307-234-9184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4559
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: