Healthcare Provider Details

I. General information

NPI: 1730452822
Provider Name (Legal Business Name): SARAH JANINE MANSOUR PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 LINCOLN BLVD
MARINA DEL REY CA
90292-8814
US

IV. Provider business mailing address

4311 LINCOLN BLVD
MARINA DEL REY CA
90292-8814
US

V. Phone/Fax

Practice location:
  • Phone: 310-821-4993
  • Fax:
Mailing address:
  • Phone: 310-821-4993
  • Fax: 310-306-6499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberCA67345
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60213396
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number67345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: