Samantha Champion – Pharmacotherapy Pharmacist

Key facts

NPI: 1487064481
Entity type: Individual (NPI type 1)
Primary specialty: Pharmacotherapy Pharmacist 1835P1200X
License: 26024705A (IN)
Practice address: 2990 N Wayne St
Angola, IN 46703-9121
Phone: (260) 668-1133
NPI assigned: Apr 30, 2014
Sex: Female
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Doctor of Pharmacy

State licenses

License	State	Type	Specialty
26024705A	IN	MD	Pharmacotherapy Pharmacist

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pharmacotherapy Pharmacist	1835P1200X	26024705A	IN	Yes

Addresses

Primary practice location

2990 N Wayne St
Angola, IN 46703-9121

Mailing address

2990 N Wayne St
Angola, IN 46703-9121
Phone (260) 668-1133

Other names

Samantha Gay Professional name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 30, 2014.

{
    "created_epoch": "1398816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398816000000",
    "number": "1487064481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2990 N WAYNE ST",
            "city": "ANGOLA",
            "state": "IN",
            "postal_code": "467039121",
            "telephone_number": "260-668-1133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2990 N WAYNE ST",
            "city": "ANGOLA",
            "state": "IN",
            "postal_code": "467039121",
            "telephone_number": "260-668-1133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMPION",
        "first_name": "SAMANTHA",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-30",
        "last_updated": "2014-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P1200X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacotherapy",
            "state": "IN",
            "license": "26024705A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "GAY",
            "credential": "PHARMD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Angola, IN

All providers in Angola, IN · Pharmacotherapy Pharmacist in Indiana

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2014. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.