Provider Demographics
NPI:1629354873
Name:SAMARA, JOANNA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:
Last Name:SAMARA
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 1:4800 148TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445-3117
Mailing Address - Country:US
Mailing Address - Phone:708-687-1604
Mailing Address - Fax:708-687-1650
Practice Address - Street 1:4800 148TH ST
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:IL
Practice Address - Zip Code:60445-3117
Practice Address - Country:US
Practice Address - Phone:708-687-1604
Practice Address - Fax:708-687-1650
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051291474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist