1740200286 NPI number — MRS. SAMANTHA J ZOSKE PHARMD

Table of content: MRS. SAMANTHA J ZOSKE PHARMD (NPI 1740200286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740200286 NPI number — MRS. SAMANTHA J ZOSKE PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZOSKE
Provider First Name:
SAMANTHA
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740200286
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 N 3RD AVE
Provider Second Line Business Mailing Address:
BOX 696
Provider Business Mailing Address City Name:
MARSHALLTOWN
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50158-1815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-752-7139
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 N 3RD AVE
Provider Second Line Business Practice Location Address:
BOX 696
Provider Business Practice Location Address City Name:
MARSHALLTOWN
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50158-1815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-752-7139
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  19860 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0461251 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1604758 . This is a "NABP" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com