Provider Demographics
NPI:1902227531
Name:SAMBERG, MARIAH ELIZABETH (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:ELIZABETH
Last Name:SAMBERG
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 NORA DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1475
Mailing Address - Country:US
Mailing Address - Phone:419-356-9748
Mailing Address - Fax:
Practice Address - Street 1:2111 E WOOSTER ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-9083
Practice Address - Country:US
Practice Address - Phone:419-373-8610
Practice Address - Fax:419-373-8665
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-28
Last Update Date:2013-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03131762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist