Provider Demographics
NPI:1912406158
Name:AMSAM ENTERPRISES LLC
Entity Type:Organization
Organization Name:AMSAM ENTERPRISES LLC
Other - Org Name:WHITE CROSS PHARMACY #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PIC
Authorized Official - Prefix:
Authorized Official - First Name:SAMEER
Authorized Official - Middle Name:
Authorized Official - Last Name:RAKHOLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-370-1336
Mailing Address - Street 1:7065 INDIANA AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4167
Mailing Address - Country:US
Mailing Address - Phone:951-370-1336
Mailing Address - Fax:951-370-1336
Practice Address - Street 1:7065 INDIANA AVE STE 310
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4167
Practice Address - Country:US
Practice Address - Phone:951-370-1336
Practice Address - Fax:951-370-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-02
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY559553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy