Active NPI
Samantha Jane Clark, PHARM.D.
- Pharmacist
- Dryden, NY
National Provider Identifier
1144869900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 066348
- Practice address
- 79 North St
Dryden, NY 13053-8510 - Phone
- (607) 844-3404
- NPI assigned
- Dec 26, 2019
- Last updated
- Nov 12, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 066348 | NY | Primary |
Addresses
Primary practice location
79 North St
Dryden, NY 13053-8510
Mailing address
2174 S Cortland Virgil Rd
Cortland, NY 13045-8984
Phone (607) 745-1877
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 066348 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1577318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636675200000",
"number": "1144869900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2174 S CORTLAND VIRGIL RD",
"city": "CORTLAND",
"state": "NY",
"postal_code": "130458984",
"telephone_number": "607-745-1877"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "79 NORTH ST",
"city": "DRYDEN",
"state": "NY",
"postal_code": "130538510",
"telephone_number": "607-844-3404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "SAMANTHA",
"middle_name": "JANE",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-12-26",
"last_updated": "2021-11-12",
"certification_date": "2021-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "066348",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dryden, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.