Provider Demographics
NPI:1346589694
Name:SAMUEL, LINDSAY NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:NICOLE
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:LINDSAY
Other - Middle Name:SAMUEL
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:11080 SAFFOLD WAY
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3812
Mailing Address - Country:US
Mailing Address - Phone:571-926-6792
Mailing Address - Fax:
Practice Address - Street 1:11080 SAFFOLD WAY
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3812
Practice Address - Country:US
Practice Address - Phone:571-926-6792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100001291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist