Provider Demographics
NPI:1477101749
Name:PIERINI, SAMUEL J (PHARMD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:PIERINI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 CHINQUAPIN DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-7409
Mailing Address - Country:US
Mailing Address - Phone:530-307-0185
Mailing Address - Fax:
Practice Address - Street 1:1375 CHINQUAPIN DR
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7409
Practice Address - Country:US
Practice Address - Phone:530-307-0185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0017427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0017427Medicaid