Provider Demographics
NPI:1588937031
Name:SKEEGAN, SAMUEL L
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:L
Last Name:SKEEGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 DAWN LN
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-1708
Mailing Address - Country:US
Mailing Address - Phone:248-497-9963
Mailing Address - Fax:
Practice Address - Street 1:4124 DAWN LN
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-1708
Practice Address - Country:US
Practice Address - Phone:248-497-9963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist