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General NPI Number Information
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NPI Number | 1497399984
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Entity Type | Individual
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Provider Name | JORDAN ASHLEY SAMAHA
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Gender | Female
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Dates
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Enumeration Date | 10/29/2019
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Last Update Date | 02/06/2020
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Provider Practice Location Address
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Address Line | 13500 HIGHWAY 90
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City | BOUTTE
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State | LA
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Zip | 70039-3500
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Country | US
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Telephone | 985-331-1886
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Fax |
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Provider Business Mailing Address
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Address Line | 4921 PRETTY LAKE AVE APT 219
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City | NORFOLK
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State | VA
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Zip | 23518-2028
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Country | US
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Telephone | 985-212-4410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202218534
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PST.023269
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License Number State | LA
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