Provider Demographics
NPI:1205611860
Name:MAMIE, SAMANTHA DENISE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DENISE
Last Name:MAMIE
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 1:770 REETZ AVE
Mailing Address - Street 2:
Mailing Address - City:HULMEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-5881
Mailing Address - Country:US
Mailing Address - Phone:215-470-0327
Mailing Address - Fax:
Practice Address - Street 1:770 REETZ AVE
Practice Address - Street 2:
Practice Address - City:HULMEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19047-5881
Practice Address - Country:US
Practice Address - Phone:215-470-0327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP457872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist