Active NPI
Samantha Clark, PHARM D
- Pharmacist
- Hattiesburg, MS
National Provider Identifier
1346719861
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- E-12595
- Practice address
- 6051 U S Highway 49
Hattiesburg, MS 39401-7201 - Phone
- (601) 288-4286
- Fax
- (601) 288-4163
- NPI assigned
- Nov 14, 2018
- 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 | E-12595 | MS | Primary |
Addresses
Primary practice location
6051 U S Highway 49
Hattiesburg, MS 39401-7201
Mailing address
312 S 17TH Ave
Hattiesburg, MS 39401-6253
Phone (601) 297-7501
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 |
|---|---|---|---|
| E-12595 | MS | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542153600000",
"number": "1346719861",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "312 S 17TH AVE",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394016253",
"telephone_number": "601-297-7501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6051 U S HIGHWAY 49",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394017201",
"telephone_number": "601-288-4286",
"fax_number": "601-288-4163"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "SAMANTHA",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-11-14",
"last_updated": "2018-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "E-12595",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hattiesburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.