MEDICARE: SAMANTHA ST JACQUE PHARMD, RPH

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	26031451A	IN

General Provider Information

NPI Number	:	1134085566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA ST JACQUE PHARMD, RPH

Provider Business Mailing Address
First Line	:	4038 HERB LEWIS RD APT 422
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-9402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 PATROL RD
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-7750
Country	:	US
Telephone Number	:	855-242-2241
Fax Number	:

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

Provider Enumeration Date	:	12/30/2025
Last Update Date	:	12/30/2025

Similar Medicare Providers

1366382228 — RACHEL FISCHER
Practice Location Address:

1050 PATROL RD
JEFFERSONVILLE, IN
47130-7750

Practice Phone: 855-427-4682
Practice Fax: 844-232-7205

1083045140 — OPTUM PHARMACY 702, LLC
Practice Location Address:

1050 PATROL RD
JEFFERSONVILLE, IN
47130-7750

Practice Phone: 855-427-4682
Practice Fax: 877-342-4596

1124643705 — BREEELLEN SHROYER PHARMD
Practice Location Address:

1050 PATROL RD
JEFFERSONVILLE, IN
47130-7750

Practice Phone: 855-427-4682
Practice Fax:

1326846585 — OPTUM PHARMACY 702, LLC
Practice Location Address:

1050 PATROL RD
JEFFERSONVILLE, IN
47130-7750

Practice Phone: 855-427-4682
Practice Fax: 877-223-1603

1518759364 — AVENIR VENTURES, L.L.C.
Practice Location Address:

305 QUARTERMASTER CT
JEFFERSONVILLE, IN
47130-3670

Practice Phone: 812-284-4630
Practice Fax: 877-830-0644

1932437779 — AMEDISYS HOSPICE LLC
Practice Location Address:

305 QUARTERMASTER CT
JEFFERSONVILLE, IN
47130-3670

Practice Phone: 812-284-4630
Practice Fax: 812-284-4856

Directions to “ SAMANTHA ST JACQUE PHARMD, RPH” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.