Provider Demographics
NPI:1699371161
Name:KAEBERLEIN, SAMANTHA MARIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MARIA
Last Name:KAEBERLEIN
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 1:405 W 62ND ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-3901
Mailing Address - Country:US
Mailing Address - Phone:330-327-0060
Mailing Address - Fax:
Practice Address - Street 1:2 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417
Practice Address - Country:US
Practice Address - Phone:912-739-0406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032415183500000X
OH03439725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist