Jordan Ashley Samaha
Individual provider Active NPI Pharmacist · Boutte, LA
NPI 1497399984 · NPPES record last updated Feb 6, 2020
Key facts
- NPI
- 1497399984
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PST.023269 (LA)
- Practice address
- 13500 Highway 90
Boutte, LA 70039-3500 - Phone
- (985) 331-1886
- NPI assigned
- Oct 29, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PST.023269 | LA | MD | Pharmacist |
| 0202218534 | VA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202218534 | VA | |
| Pharmacist | 183500000X | PST.023269 | LA | Yes |
Addresses
Primary practice location
13500 Highway 90
Boutte, LA 70039-3500
Mailing address
4921 Pretty Lake Ave Apt 219
Norfolk, VA 23518-2028
Phone (985) 212-4410
Other practice location 1
150 Loupe St
Luling, LA 70070-4040
Phone (985) 212-4410
Other names
- Jordan Ashley Laurent
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | rem.09861@store.walgreens.com | Direct |
Other providers in Boutte, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2020. 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.