Provider Demographics
NPI:1831368794
Name:SAMPAYAN, MICHELE MAHAL ORDINARIO (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:MAHAL ORDINARIO
Last Name:SAMPAYAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:MAHAL SAMPAYAN
Other - Last Name:SERRANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4102 PINION DR
Mailing Address - Street 2:
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-2502
Mailing Address - Country:US
Mailing Address - Phone:719-333-9688
Mailing Address - Fax:
Practice Address - Street 1:4102 PINION DR
Practice Address - Street 2:
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-2502
Practice Address - Country:US
Practice Address - Phone:719-333-9688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2002608183500000X
CO18022183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist