Provider Demographics
NPI:1346593266
Name:SAMPLASKI, WARREN W (RPH)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:W
Last Name:SAMPLASKI
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:W2854 STATE ROAD 67
Mailing Address - Street 2:
Mailing Address - City:IRON RIDGE
Mailing Address - State:WI
Mailing Address - Zip Code:53035-9616
Mailing Address - Country:US
Mailing Address - Phone:920-763-2694
Mailing Address - Fax:
Practice Address - Street 1:205 VALLEY AVE
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-5312
Practice Address - Country:US
Practice Address - Phone:262-338-2311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10936-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist