Healthcare Provider Details

I. General information

NPI: 1083934764
Provider Name (Legal Business Name): SALIM JAMIL DAOUK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 STOCKTON BLVD
SACRAMENTO CA
95824-1612
US

IV. Provider business mailing address

9974 SPRING VIEW WAY
ELK GROVE CA
95757-3304
US

V. Phone/Fax

Practice location:
  • Phone: 916-737-0260
  • Fax: 916-737-0269
Mailing address:
  • Phone: 916-714-0677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: