Provider Demographics
NPI:1326202698
Name:SAMRA, CHARONJIT KAUR (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHARONJIT
Middle Name:KAUR
Last Name:SAMRA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CHARONJIT
Other - Middle Name:KAUR
Other - Last Name:SIDHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1007 INTERLAKEN DR
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-9174
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8241 E STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-8200
Practice Address - Country:US
Practice Address - Phone:169-525-6907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist