Provider Demographics
NPI:1417549577
Name:DOW, SAMANTHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:DOW
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:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:GREENE
Mailing Address - State:IA
Mailing Address - Zip Code:50636-0639
Mailing Address - Country:US
Mailing Address - Phone:641-816-3013
Mailing Address - Fax:
Practice Address - Street 1:104 E TRAER ST STE 101
Practice Address - Street 2:
Practice Address - City:GREENE
Practice Address - State:IA
Practice Address - Zip Code:50636-7702
Practice Address - Country:US
Practice Address - Phone:641-816-3013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist