Provider Demographics
NPI:1144504903
Name:BERKLEY, SAMANTHA LYNN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:LYNN
Last Name:BERKLEY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3911
Mailing Address - Country:US
Mailing Address - Phone:731-423-1131
Mailing Address - Fax:
Practice Address - Street 1:601 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3911
Practice Address - Country:US
Practice Address - Phone:731-423-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist