Provider Demographics
NPI:1598815417
Name:SAMBAR CORPORATION
Entity Type:Organization
Organization Name:SAMBAR CORPORATION
Other - Org Name:MEDICAL SQUARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-483-1744
Mailing Address - Street 1:2100 W 3RD ST
Mailing Address - Street 2:SUITE 190
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1922
Mailing Address - Country:US
Mailing Address - Phone:213-483-1744
Mailing Address - Fax:213-483-3654
Practice Address - Street 1:2100 W 3RD ST
Practice Address - Street 2:SUITE 190
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1922
Practice Address - Country:US
Practice Address - Phone:213-483-1744
Practice Address - Fax:213-483-3654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY364700333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy