Provider Demographics
NPI:1497181838
Name:HOLM, SAMANTHA JAYNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JAYNE
Last Name:HOLM
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 1:956 6TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072-2347
Mailing Address - Country:US
Mailing Address - Phone:701-430-0180
Mailing Address - Fax:
Practice Address - Street 1:120 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-3319
Practice Address - Country:US
Practice Address - Phone:701-845-1763
Practice Address - Fax:701-845-5171
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH5596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist