Provider Demographics
NPI:1184954091
Name:SAMRA, SHEILA (BSC, PHARM)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:SAMRA
Suffix:
Gender:F
Credentials:BSC, PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6194 175A ST
Mailing Address - Street 2:
Mailing Address - City:SURREY
Mailing Address - State:BC
Mailing Address - Zip Code:V3S4B7
Mailing Address - Country:CA
Mailing Address - Phone:360-734-0229
Mailing Address - Fax:360-734-0658
Practice Address - Street 1:4090 GUIDE MERIDIAN
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-5517
Practice Address - Country:US
Practice Address - Phone:360-734-0229
Practice Address - Fax:360-734-0658
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00045795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist