Provider Demographics
NPI:1447591995
Name:POSTOLSKI070, SAM JACK
Entity Type:Individual
Prefix:MR
First Name:SAM
Middle Name:JACK
Last Name:POSTOLSKI070
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 S MAIN ST
Mailing Address - Street 2:2805 S MAIN ST
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27263-1936
Mailing Address - Country:US
Mailing Address - Phone:336-431-1149
Mailing Address - Fax:336-431-8423
Practice Address - Street 1:2805 S MAIN ST
Practice Address - Street 2:2805 S MAIN ST
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27263-1936
Practice Address - Country:US
Practice Address - Phone:336-431-1149
Practice Address - Fax:336-431-8423
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist