Healthcare Provider Details

I. General information

NPI: 1811618739
Provider Name (Legal Business Name): SAMANTHA ELIZABETH WEISBROD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 N CANTON CENTER RD
CANTON MI
48187-2954
US

IV. Provider business mailing address

43142 HADLEY CT
CANTON MI
48188-1916
US

V. Phone/Fax

Practice location:
  • Phone: 734-844-2677
  • Fax:
Mailing address:
  • Phone: 734-890-2168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302414566
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: