Provider Demographics
NPI:1922548338
Name:CHI, SAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:CHI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18741 DEODAR ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7220
Mailing Address - Country:US
Mailing Address - Phone:800-219-9462
Mailing Address - Fax:800-219-9498
Practice Address - Street 1:11205 KNOTT AVE
Practice Address - Street 2:SUITE C
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5489
Practice Address - Country:US
Practice Address - Phone:800-219-9462
Practice Address - Fax:800-219-9498
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist