Provider Demographics
NPI:1033125869
Name:SAMPSON, CHARLENE (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:SAMPSON
Suffix:
Gender:F
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:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:ND
Mailing Address - Zip Code:58530-0122
Mailing Address - Country:US
Mailing Address - Phone:701-794-3618
Mailing Address - Fax:701-530-6317
Practice Address - Street 1:1000 E ROSSER AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4414
Practice Address - Country:US
Practice Address - Phone:701-530-6311
Practice Address - Fax:701-530-6317
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist