MEDICARE: SHERWIN BABADILLA SAMSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH 59357	CA

General Provider Information

NPI Number	:	1376863001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERWIN BABADILLA SAMSON

Provider Business Mailing Address
First Line	:	947 FLETCHER LN APT 223
Second Line	:
City	:	HAYWARD
State	:	CA
Zip	:	94544-1063
Country	:	US
Telephone Number	:	510-331-6198
Fax Number	:

Provider Business Practice Location Address
First Line	:	1355 MACARTHUR BLVD
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-3918
Country	:	US
Telephone Number	:	510-352-3677
Fax Number	:	510-352-7102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2010
Last Update Date	:	06/04/2010

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