Healthcare Provider Details

I. General information

NPI: 1114277852
Provider Name (Legal Business Name): SEKINAH CHARLTON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SEKINAH SAMADI PHARMD

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 NEZ PERCE DR
LEWISTON ID
83501-4116
US

IV. Provider business mailing address

2102 NEZ PERCE DR
LEWISTON ID
83501-4116
US

V. Phone/Fax

Practice location:
  • Phone: 208-743-4434
  • Fax:
Mailing address:
  • Phone: 208-743-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberIR60225984
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE18570
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP8337
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: