Provider Demographics
NPI:1295095602
Name:SAMPSON, DANIELLE LEANNE
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:LEANNE
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 EASTSIDE HWY
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870-2224
Mailing Address - Country:US
Mailing Address - Phone:406-777-5002
Mailing Address - Fax:
Practice Address - Street 1:3804 EASTSIDE HWY
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-2224
Practice Address - Country:US
Practice Address - Phone:406-777-5002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9505183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist