Provider Demographics
NPI:1912310426
Name:SAMBERG, PETER JOSEPH II (PHARMD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:JOSEPH
Last Name:SAMBERG
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4404
Mailing Address - Country:US
Mailing Address - Phone:419-472-8027
Mailing Address - Fax:419-475-0050
Practice Address - Street 1:3911 SECOR RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4404
Practice Address - Country:US
Practice Address - Phone:419-472-8027
Practice Address - Fax:419-475-0050
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03232913-2183500000X
OH066008730183500000X
MI5302042097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist