Provider Demographics
NPI:1407089337
Name:HAKES, SAMANTHA JOANN (CPHT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JOANN
Last Name:HAKES
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4514 NE103RD ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-5997
Mailing Address - Country:US
Mailing Address - Phone:360-521-1460
Mailing Address - Fax:
Practice Address - Street 1:4514 NE103RD ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-5997
Practice Address - Country:US
Practice Address - Phone:360-521-1460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCPT-0005436183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician