Active NPI
Samantha Disney
- Pharmacist
- Valparaiso, IN
National Provider Identifier
1508466301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26024560A
- Practice address
- 2400 Morthland Dr
Valparaiso, IN 46383-8329 - Phone
- (219) 465-1717
- NPI assigned
- Oct 29, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051300331 | IL | |
| Pharmacist | 183500000X | 26024560A | IN | Primary |
Addresses
Primary practice location
2400 Morthland Dr
Valparaiso, IN 46383-8329
Mailing address
2400 Morthland Dr
Valparaiso, IN 46383-8329
Phone (219) 465-1717
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051300331 | IL | MD | Pharmacist |
| 26024560A | IN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603929600000",
"number": "1508466301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2400 MORTHLAND DR",
"city": "VALPARAISO",
"state": "IN",
"postal_code": "463838329",
"telephone_number": "219-465-1717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 MORTHLAND DR",
"city": "VALPARAISO",
"state": "IN",
"postal_code": "463838329",
"telephone_number": "219-465-1717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISNEY",
"first_name": "SAMANTHA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-29",
"last_updated": "2020-10-29",
"certification_date": "2020-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051300331",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26024560A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valparaiso, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.