Healthcare Provider Details

I. General information

NPI: 1780973149
Provider Name (Legal Business Name): MR. ERNEST C SAMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7844 STATE ROUTE 45
LISBON OH
44432-9396
US

IV. Provider business mailing address

130 N ELM ST
COLUMBIANA OH
44408-1141
US

V. Phone/Fax

Practice location:
  • Phone: 330-424-7743
  • Fax:
Mailing address:
  • Phone: 330-482-9569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberO3313448
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP029855L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: