Provider Demographics
NPI:1912442310
Name:VEAZEY, SAMANTHA (PHARMD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:VEAZEY
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 1:1200 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5232
Mailing Address - Country:US
Mailing Address - Phone:337-280-9013
Mailing Address - Fax:
Practice Address - Street 1:1710 LOUISVILLE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6030
Practice Address - Country:US
Practice Address - Phone:318-322-3141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.020615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist