Provider Demographics
NPI:1063979235
Name:SAMPSON, MATTHEW PATRICK (RPH)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:PATRICK
Last Name:SAMPSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 NASON ST
Mailing Address - Street 2:
Mailing Address - City:CHESANING
Mailing Address - State:MI
Mailing Address - Zip Code:48616-1141
Mailing Address - Country:US
Mailing Address - Phone:989-225-0481
Mailing Address - Fax:
Practice Address - Street 1:9900 W M 21 STE 103
Practice Address - Street 2:
Practice Address - City:OVID
Practice Address - State:MI
Practice Address - Zip Code:48866-9798
Practice Address - Country:US
Practice Address - Phone:989-862-4858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist