MEDICARE: DR. SARA SAMARA ATALLAH PHARMD

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	71613	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	71613	OTHER	CA	CA BOARD OF PHARMACY LICENSE

General Provider Information

NPI Number	:	1699154823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA SAMARA ATALLAH PHARMD

Provider Business Mailing Address
First Line	:	1327 EL PRADO AVE
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90501-2716
Country	:	US
Telephone Number	:	310-328-7244
Fax Number	:	310-782-3519

Provider Business Practice Location Address
First Line	:	2860 ARTESIA BLVD
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-3421
Country	:	US
Telephone Number	:	310-371-7541
Fax Number	:	310-542-1488

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

Provider Enumeration Date	:	05/20/2015
Last Update Date	:	05/20/2015

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