Provider Demographics
NPI:1740955541
Name:EHRESMAN, SAMANTHA MICHELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MICHELLE
Last Name:EHRESMAN
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 1:13006 W 116TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-3523
Mailing Address - Country:US
Mailing Address - Phone:913-742-0263
Mailing Address - Fax:
Practice Address - Street 1:105 S OAK ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-3436
Practice Address - Country:US
Practice Address - Phone:417-667-7802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021032471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist