Provider Demographics
NPI:1316294432
Name:PELHAM, SAMANTHA DIANNE (PHARMD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DIANNE
Last Name:PELHAM
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 1:21 BRAXTON ST
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-5227
Mailing Address - Country:US
Mailing Address - Phone:256-468-6017
Mailing Address - Fax:
Practice Address - Street 1:21 BRAXTON ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-5227
Practice Address - Country:US
Practice Address - Phone:256-468-6017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist