Individual
SAMANTHA DISNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2400 MORTHLAND DR, VALPARAISO, IN 46383-8329
(219) 465-1717
Mailing address
2400 MORTHLAND DR, VALPARAISO, IN 46383-8329
(219) 465-1717
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
051300331
IL
183500000X
Pharmacist
Primary
26024560A
IN
Other
Enumeration date
10/29/2020
Last updated
10/29/2020
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