Basic Information
| Provider Information | |||||||||
| NPI: | 1437711132 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | MAREE | ||||||||
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| Credential: | PHARM. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3920 W 48TH ST | ||||||||
| Address2: | |||||||||
| City: | ROELAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662051415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022782289 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2200 SW GAGE BLVD | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666220001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853503111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2019 | ||||||||
| LastUpdateDate: | 07/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 1-105868 | KS | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 2018027955 | MO | N | Pharmacy Service Providers | Pharmacist |
No ID Information.