Provider Demographics
NPI:1346517349
Name:SAMS, DEAN J (RPH)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:J
Last Name:SAMS
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 1:1660 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-3636
Mailing Address - Country:US
Mailing Address - Phone:563-324-3508
Mailing Address - Fax:563-324-4025
Practice Address - Street 1:14 E 61ST CT
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2949
Practice Address - Country:US
Practice Address - Phone:563-355-5319
Practice Address - Fax:563-324-4025
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-19
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17133183500000X
IL051-037096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist