Provider Demographics
NPI:1881931160
Name:SAMPLES, ZACHARY MICHAEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:MICHAEL
Last Name:SAMPLES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BONNIE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-3216
Mailing Address - Country:US
Mailing Address - Phone:217-473-4307
Mailing Address - Fax:
Practice Address - Street 1:6 BONNIE LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-3216
Practice Address - Country:US
Practice Address - Phone:217-473-4307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.295719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist