Provider Demographics
NPI:1972192052
Name:BORAIE, SAMI M (RPH)
Entity Type:Individual
Prefix:MR
First Name:SAMI
Middle Name:M
Last Name:BORAIE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 TOWN CTR W STE 123
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-5075
Mailing Address - Country:US
Mailing Address - Phone:805-720-7218
Mailing Address - Fax:
Practice Address - Street 1:830 GUADALUPE ST
Practice Address - Street 2:
Practice Address - City:GUADALUPE
Practice Address - State:CA
Practice Address - Zip Code:93434-1330
Practice Address - Country:US
Practice Address - Phone:805-219-0770
Practice Address - Fax:805-219-0772
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist