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NPI Code Detail

MEDICARE: SAMANTHA JULIA SALAS PHARMD

MEDICARE: SAMANTHA JULIA SALAS 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
1183500000XPharmacist023723KY

General Provider Information

NPI Number : 1366273732
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA JULIA SALAS PHARMD
Provider Business Mailing Address
First Line : 1032 SIVLEY RD
Second Line :
City : HOPKINSVILLE
State : KY
Zip : 42240-7941
Country : US
Telephone Number : 615-478-8655
Fax Number :
Provider Business Practice Location Address
First Line : 14800 FORT CAMPBELL BLVD
Second Line :
City : OAK GROVE
State : KY
Zip : 42262-8304
Country : US
Telephone Number : 270-640-5848
Fax Number : 270-640-5844
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2024
Last Update Date : 08/08/2024

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