Provider Demographics
NPI:1821600958
Name:SAZEGAR, SAM (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:SAZEGAR
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 W HORIZON RIDGE PKWY APT 3323
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5768
Mailing Address - Country:US
Mailing Address - Phone:310-985-2811
Mailing Address - Fax:
Practice Address - Street 1:787 L ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-2822
Practice Address - Country:US
Practice Address - Phone:707-464-3857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA823171835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy