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General NPI Number Information
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NPI Number | 1972952729
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Entity Type | Individual
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Provider Name | JACKLYN SAMPSON PHARMD
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Gender | Female
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Dates
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Enumeration Date | 06/11/2016
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Last Update Date | 06/11/2016
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Provider Practice Location Address
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Address Line | 5400 ALEXANDRIA PIKE
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City | COLD SPRING
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State | KY
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Zip | 41076-2169
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Country | US
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Telephone | 859-448-4210
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Fax |
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Provider Business Mailing Address
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Address Line | 110 GREEN HILL DR
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City | COVINGTON
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State | KY
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Zip | 41017-9431
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Country | US
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Telephone | 859-640-4990
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 03135751
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License Number State | OH
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