Provider Demographics
NPI:1760254676
Name:CANTO, SAMANTHA ALEXIS
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ALEXIS
Last Name:CANTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 W 54TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2725
Mailing Address - Country:US
Mailing Address - Phone:786-302-0078
Mailing Address - Fax:
Practice Address - Street 1:3300 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33328-2004
Practice Address - Country:US
Practice Address - Phone:800-541-6682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS64979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist