Provider Demographics
NPI:1043930076
Name:MELLINGER, SAMANTHA (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MELLINGER
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 SIGNATURE WAY APT 431
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5956
Mailing Address - Country:US
Mailing Address - Phone:406-590-7679
Mailing Address - Fax:
Practice Address - Street 1:5914 HIGH ST W
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-4506
Practice Address - Country:US
Practice Address - Phone:757-484-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202220744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist