Provider Demographics
NPI:1477911923
Name:SAMAAN, GEORGE
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:SAMAAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 N CROWE ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8071
Mailing Address - Country:US
Mailing Address - Phone:559-372-4568
Mailing Address - Fax:
Practice Address - Street 1:2705 N CROWE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-8071
Practice Address - Country:US
Practice Address - Phone:559-372-4568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA60904OtherSTATE BOARD OF PHARMACY