Provider Demographics
NPI:1003533258
Name:SOCCO, SAMANTHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:SOCCO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17W726 BUTTERFIELD RD APT 114
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4227
Mailing Address - Country:US
Mailing Address - Phone:773-899-2135
Mailing Address - Fax:
Practice Address - Street 1:6960 CINTAS BLVD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-8922
Practice Address - Country:US
Practice Address - Phone:773-899-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist