Provider Demographics
NPI:1952883365
Name:SHAMOUN, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SHAMOUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 TOWN CTR W
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-5076
Mailing Address - Country:US
Mailing Address - Phone:805-925-1167
Mailing Address - Fax:805-349-9366
Practice Address - Street 1:345 TOWN CTR W
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-5076
Practice Address - Country:US
Practice Address - Phone:805-925-1167
Practice Address - Fax:805-349-9366
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist