Provider Demographics
NPI:1508068370
Name:CRUZ, SAMILINE B (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:SAMILINE
Middle Name:B
Last Name:CRUZ
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 BRET HARTE WAY
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-1925
Mailing Address - Country:US
Mailing Address - Phone:415-454-1451
Mailing Address - Fax:415-454-2865
Practice Address - Street 1:121 TUNSTEAD AVE
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2616
Practice Address - Country:US
Practice Address - Phone:415-454-1451
Practice Address - Fax:415-454-2865
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH 60861183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician