Provider Demographics
NPI:1750676979
Name:SAMPIERI, MARK EMILIO (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EMILIO
Last Name:SAMPIERI
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 1:605 N COLONY RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-3109
Mailing Address - Country:US
Mailing Address - Phone:203-265-3600
Mailing Address - Fax:
Practice Address - Street 1:605 N COLONY RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-3109
Practice Address - Country:US
Practice Address - Phone:203-265-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0006738183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist