Provider Demographics
NPI:1255505467
Name:WILLICK, SAMANTHA MARIE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:MARIE
Last Name:WILLICK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:SAMANTHA
Other - Middle Name:MARIE
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:603 E SAVIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1956
Mailing Address - Country:US
Mailing Address - Phone:616-842-1461
Mailing Address - Fax:
Practice Address - Street 1:603 E SAVIDGE ST
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-1956
Practice Address - Country:US
Practice Address - Phone:616-842-1461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist