Provider Demographics
NPI:1043978273
Name:FLORDELIS, SAMANTHA JEANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JEANNE
Last Name:FLORDELIS
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 1:10055 RIDGE RD UNIT 2104
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1277
Mailing Address - Country:US
Mailing Address - Phone:909-557-7630
Mailing Address - Fax:
Practice Address - Street 1:15301 E MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-3064
Practice Address - Country:US
Practice Address - Phone:303-751-5694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-05
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0023867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist