Provider Demographics
NPI:1255620118
Name:SAMPLES, RICHARD LESLIE
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LESLIE
Last Name:SAMPLES
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 1:4880 US HIGHWAY 78 W
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-6100
Mailing Address - Country:US
Mailing Address - Phone:256-831-7726
Mailing Address - Fax:256-835-8123
Practice Address - Street 1:4880 US HIGHWAY 78 W
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-6100
Practice Address - Country:US
Practice Address - Phone:256-831-7726
Practice Address - Fax:256-835-8123
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist