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General NPI Number Information
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NPI Number | 1063189140
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Entity Type | Individual
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Provider Name | JUSTIN DARRELL SANSOM PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 08/25/2021
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 911 BYPASS RD
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City | PIKEVILLE
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State | KY
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Zip | 41501-1602
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Country | US
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Telephone | 606-430-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 65 COLEMAN RD
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City | ELKHORN CITY
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State | KY
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Zip | 41522-7864
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Country | US
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Telephone | 606-213-7228
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835C0207X
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Taxonomy Name | Compounded Sterile Preparations Pharmacist
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License Number | 022244
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 022244
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 022244
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License Number State | KY
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