Provider Demographics
NPI:1467093021
Name:KENIK, SAMANTHA ELYSE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:ELYSE
Last Name:KENIK
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 1:1710 S 58TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2224
Mailing Address - Country:US
Mailing Address - Phone:402-490-7859
Mailing Address - Fax:
Practice Address - Street 1:3308 SAMSON WAY STE 106
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-3235
Practice Address - Country:US
Practice Address - Phone:402-291-5076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist