Provider Demographics
NPI:1083274658
Name:SAMSAMI, SEAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:SAMSAMI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15119 BURBANK BLVD APT 9
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-3564
Mailing Address - Country:US
Mailing Address - Phone:310-806-0198
Mailing Address - Fax:
Practice Address - Street 1:39440 10TH ST W
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3747
Practice Address - Country:US
Practice Address - Phone:661-265-7361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist