Provider Demographics
NPI:1306387576
Name:SAMPSON, SHARON
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
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:989-225-0482
Mailing Address - Fax:
Practice Address - Street 1:826 W KING ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2120
Practice Address - Country:US
Practice Address - Phone:989-729-4855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist