Provider Demographics
NPI:1134956485
Name:ASUMADU, SAMPSON A (RPH)
Entity type:Individual
Prefix:MR
First Name:SAMPSON
Middle Name:A
Last Name:ASUMADU
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 1:16 HEATHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-1619
Mailing Address - Country:US
Mailing Address - Phone:508-789-4593
Mailing Address - Fax:
Practice Address - Street 1:833 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4701
Practice Address - Country:US
Practice Address - Phone:781-643-4272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist