Provider Demographics
NPI:1730940065
Name:LOUIS, SAMANTHA WANG (PHARMD, MPH)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:WANG
Last Name:LOUIS
Suffix:
Gender:F
Credentials:PHARMD, MPH
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:SUHUI
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, MPH
Mailing Address - Street 1:5015 TAPESTRY TER
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6548
Mailing Address - Country:US
Mailing Address - Phone:859-285-7139
Mailing Address - Fax:
Practice Address - Street 1:2301 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4699
Practice Address - Country:US
Practice Address - Phone:919-681-5693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC269671835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy