Provider Demographics
NPI:1962967612
Name:SAMPSON, JORDAN L (PHARMD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:L
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:WORTHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:462 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-2026
Mailing Address - Country:US
Mailing Address - Phone:330-310-8206
Mailing Address - Fax:
Practice Address - Street 1:8333 ROCKSIDE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44125-6134
Practice Address - Country:US
Practice Address - Phone:877-355-7225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03338154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist