Healthcare Provider Details

I. General information

NPI: 1942914403
Provider Name (Legal Business Name): SAMARA JASMINE WHITE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 MORSE AVE
SACRAMENTO CA
95825-2135
US

IV. Provider business mailing address

3690 DUCKHORN DR APT 3064
SACRAMENTO CA
95834-1330
US

V. Phone/Fax

Practice location:
  • Phone: 916-973-5499
  • Fax:
Mailing address:
  • Phone: 408-624-7395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number069955-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number89969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: