Provider Demographics
NPI:1609138346
Name:TESTA, SAMUEL JOHN (RPH)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:JOHN
Last Name:TESTA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1601 STATE AVE NW
Mailing Address - Street 2:STERLING LONG TERM CARE PHARMACY
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-5689
Mailing Address - Country:US
Mailing Address - Phone:507-455-9684
Mailing Address - Fax:507-455-1750
Practice Address - Street 1:1601 STATE AVE NW
Practice Address - Street 2:STERLING LONG TERM CARE PHARMACY
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-5689
Practice Address - Country:US
Practice Address - Phone:507-455-9684
Practice Address - Fax:507-455-1750
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN112884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist