Provider Demographics
NPI:1013293703
Name:AZIZ, SAMAR (RPH)
Entity Type:Individual
Prefix:DR
First Name:SAMAR
Middle Name:
Last Name:AZIZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 AUGUSTA WAY
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782
Mailing Address - Country:US
Mailing Address - Phone:714-618-0435
Mailing Address - Fax:
Practice Address - Street 1:721 S GLASGOW AVE SUITE C
Practice Address - Street 2:
Practice Address - City:INGELWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301
Practice Address - Country:US
Practice Address - Phone:310-665-1131
Practice Address - Fax:310-665-1141
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA448650Medicaid