Provider Demographics
NPI:1689164840
Name:SUH, SAMANTHA Y (RPH)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:Y
Last Name:SUH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 OLD DENTON RD STE 305
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5017
Mailing Address - Country:US
Mailing Address - Phone:972-810-0078
Mailing Address - Fax:972-810-0097
Practice Address - Street 1:3044 OLD DENTON RD STE 305
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5017
Practice Address - Country:US
Practice Address - Phone:972-810-0078
Practice Address - Fax:972-810-0097
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty