Provider Demographics
NPI:1093874844
Name:VARDA SAMBOUL
Entity Type:Organization
Organization Name:VARDA SAMBOUL
Other - Org Name:S&S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VARDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMBOUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-222-7982
Mailing Address - Street 1:2922 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-1233
Mailing Address - Country:US
Mailing Address - Phone:323-222-7982
Mailing Address - Fax:323-222-3207
Practice Address - Street 1:2922 DIVISION ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-1233
Practice Address - Country:US
Practice Address - Phone:323-222-7982
Practice Address - Fax:323-222-3207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY434970Medicaid
CAPHY434970Medicaid