Provider Demographics
NPI:1831471523
Name:GAMMAGE, SAMANTHA (PHARM D)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:GAMMAGE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7631 GALL BLVD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-4321
Mailing Address - Country:US
Mailing Address - Phone:813-782-4110
Mailing Address - Fax:813-780-5264
Practice Address - Street 1:7631 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-4321
Practice Address - Country:US
Practice Address - Phone:813-782-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46780183500000X
FLFLPS46780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist