Provider Demographics
NPI:1497423040
Name:SAFA, SAMANTHA TOLENTINO
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:TOLENTINO
Last Name:SAFA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 SAM RITTENBERG BLVD STE 134
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4629
Mailing Address - Country:US
Mailing Address - Phone:843-642-6355
Mailing Address - Fax:
Practice Address - Street 1:2000 SAM RITTENBERG BLVD STE 134
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4629
Practice Address - Country:US
Practice Address - Phone:843-818-4638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist