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General NPI Number Information
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NPI Number | 1255916581
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Entity Type | Individual
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Provider Name | ANHAO SAM PHARMD
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Gender | Male
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Dates
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Enumeration Date | 03/17/2021
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Last Update Date | 03/17/2021
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Provider Practice Location Address
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Address Line | 730 17TH ST
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City | MODESTO
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State | CA
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Zip | 95354-1209
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Country | US
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Telephone | 209-248-7519
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Fax |
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Provider Business Mailing Address
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Address Line | 9940 DIAMONTE WAY
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City | SACRAMENTO
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State | CA
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Zip | 95829-8147
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Country | US
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Telephone | 760-519-9671
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH84301
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License Number State | CA
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