Provider Demographics
NPI:1366855215
Name:FARAG, SAMY SAAD (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SAMY
Middle Name:SAAD
Last Name:FARAG
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7393 ESTANCIA COURT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739
Mailing Address - Country:US
Mailing Address - Phone:909-257-5907
Mailing Address - Fax:909-949-1258
Practice Address - Street 1:7393 ESTANCIA CT
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-8560
Practice Address - Country:US
Practice Address - Phone:909-257-5907
Practice Address - Fax:909-949-1258
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist