Provider Demographics
NPI:1629699699
Name:RICKS, SAMANTHA CAMILLE (PHARMD, BCPP)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:CAMILLE
Last Name:RICKS
Suffix:
Gender:F
Credentials:PHARMD, BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2641 E COLLEGE AVE APT 736
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3380
Mailing Address - Country:US
Mailing Address - Phone:773-957-3903
Mailing Address - Fax:
Practice Address - Street 1:2641 E COLLEGE AVE APT 736
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3380
Practice Address - Country:US
Practice Address - Phone:773-957-3903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19846183500000X
IN26025426A183500000X
IL051290197183500000X
GARPH030503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist