Healthcare Provider Details

I. General information

NPI: 1548555352
Provider Name (Legal Business Name): SAMPSON TONA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 CANAL ST
BRATTLEBORO VT
05301-7112
US

IV. Provider business mailing address

65 FRANK ST APT 126
WORCESTER MA
01604-1068
US

V. Phone/Fax

Practice location:
  • Phone: 802-257-4204
  • Fax: 802-257-4766
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202209770
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033.0052966
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH232502
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR2228
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: