=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003533258
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMANTHA SOCCO PHARM.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2022
-----------------------------------------------------
Last Update Date | 10/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6960 CINTAS BLVD
-----------------------------------------------------
City | MASON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45040-8922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-899-2135
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17W726 BUTTERFIELD RD APT 114
-----------------------------------------------------
City | OAKBROOK TERRACE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60181-4227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-899-2135
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 051303114
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------