Provider Demographics
NPI:1639491491
Name:WALTON, SAMANTHA LAURA LEE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LAURA LEE
Last Name:WALTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MRS
Other - First Name:SAMANTHA
Other - Middle Name:LAURA LEE
Other - Last Name:LACEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1934 STATE ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-8310
Mailing Address - Country:US
Mailing Address - Phone:845-292-4114
Mailing Address - Fax:
Practice Address - Street 1:1934 STATE ROUTE 52
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-8310
Practice Address - Country:US
Practice Address - Phone:845-796-7200
Practice Address - Fax:845-791-4577
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2023-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053507-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist