Active NPI
Samantha Jo Ridley, PHARM.D
- Pharmacist
- Rolla, MO
National Provider Identifier
1639645591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2018026729
- Practice address
- 1375 E 10TH St Suite B
Rolla, MO 65401 - Phone
- (573) 364-9616
- NPI assigned
- Oct 18, 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 | 2018026729 | MO | Primary |
Addresses
Primary practice location
1375 E 10TH St Suite B
Rolla, MO 65401
Mailing address
PO Box 528
Cuba, MO 65453
Phone (573) 885-0885
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 |
|---|---|---|---|
| 2018026729 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720569600000",
"number": "1639645591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 528",
"city": "CUBA",
"state": "MO",
"postal_code": "65453",
"telephone_number": "573-885-0885",
"fax_number": "573-885-0882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1375 E 10TH ST SUITE B",
"city": "ROLLA",
"state": "MO",
"postal_code": "65401",
"telephone_number": "573-364-9616"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDLEY",
"first_name": "SAMANTHA",
"middle_name": "JO",
"name_prefix": "Miss",
"credential": "PHARM.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-18",
"last_updated": "2024-07-10",
"certification_date": "2024-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2018026729",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rolla, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.