Provider Demographics
NPI:1609297480
Name:ONTKO, SAMUEL (RPH)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:ONTKO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:ONTKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4702 MILAN RD
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-8911
Mailing Address - Country:US
Mailing Address - Phone:419-627-7910
Mailing Address - Fax:419-627-7965
Practice Address - Street 1:4702 MILAN RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-8911
Practice Address - Country:US
Practice Address - Phone:419-627-7910
Practice Address - Fax:419-627-7965
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03318727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist