Provider Demographics
NPI:1902219579
Name:VANG, SAM (SUI) (PHARM D)
Entity Type:Individual
Prefix:
First Name:SAM (SUI)
Middle Name:
Last Name:VANG
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 1:695 U ST
Mailing Address - Street 2:
Mailing Address - City:RIO LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:95673-1443
Mailing Address - Country:US
Mailing Address - Phone:916-419-6644
Mailing Address - Fax:916-419-4764
Practice Address - Street 1:4650 NATOMAS BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-1217
Practice Address - Country:US
Practice Address - Phone:916-419-6644
Practice Address - Fax:916-419-4764
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist