Provider Demographics
NPI:1952006835
Name:EGBERT, SAMANTHA L (RPH)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:L
Last Name:EGBERT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 S NEW FLORISSANT RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8123
Mailing Address - Country:US
Mailing Address - Phone:314-830-3282
Mailing Address - Fax:
Practice Address - Street 1:1550 S NEW FLORISSANT RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8123
Practice Address - Country:US
Practice Address - Phone:314-830-3282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003003390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist