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General NPI Number Information
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NPI Number | 1942403340
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Entity Type | Individual
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Provider Name | TRACY ELIZABETH SAMSON RPH
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Gender | Female
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 24 3RD ST NE
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City | OSSEO
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State | MN
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Zip | 55369-1212
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Country | US
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Telephone | 763-493-5242
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Fax | 763-493-2621
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Provider Business Mailing Address
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Address Line | 15681 84TH PL N
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City | MAPLE GROVE
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State | MN
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Zip | 55311-1560
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Country | US
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Telephone | 763-420-7861
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 116412-3
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 3861
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License Number State | ND
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