Provider Demographics
NPI:1366273732
Name:SALAS, SAMANTHA JULIA (PHARMD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JULIA
Last Name:SALAS
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 1:1032 SIVLEY RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-7941
Mailing Address - Country:US
Mailing Address - Phone:615-478-8655
Mailing Address - Fax:
Practice Address - Street 1:14800 FORT CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:KY
Practice Address - Zip Code:42262-8304
Practice Address - Country:US
Practice Address - Phone:270-640-5848
Practice Address - Fax:270-640-5844
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY023723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist