MEDICARE: SAMANTHA JO REDFERN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	30214	NC
2	183500000X	Pharmacist	058232	NY

General Provider Information

NPI Number	:	1043613391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA JO REDFERN PHARMD

Provider Business Mailing Address
First Line	:	1295 E MAIN ST
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-5947
Country	:	US
Telephone Number	:	803-324-7563
Fax Number	:	803-980-6109

Provider Business Practice Location Address
First Line	:	5000 FALLS OF NEUSE RD
Second Line	:	SUITE 300
City	:	RALEIGH
State	:	NC
Zip	:	27609-5480
Country	:	US
Telephone Number	:	984-200-1549
Fax Number	:	984-200-2542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2014
Last Update Date	:	09/07/2023

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