Provider Demographics
NPI:1407490659
Name:DAO, SAMANTHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:DAO
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 1:4524 75TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-1132
Mailing Address - Country:US
Mailing Address - Phone:515-991-6526
Mailing Address - Fax:
Practice Address - Street 1:4524 75TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-1132
Practice Address - Country:US
Practice Address - Phone:515-991-6526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist