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General NPI Number Information
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NPI Number | 1427421817
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Entity Type | Individual
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Provider Name | SAI MOUA PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/06/2015
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Last Update Date | 11/06/2015
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Provider Practice Location Address
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Address Line | 5450 DEWEY DR
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City | FAIR OAKS
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State | CA
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Zip | 95628-3138
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Country | US
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Telephone | 916-904-5356
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Fax |
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Provider Business Mailing Address
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Address Line | 1836 CASTERBRIDGE DR
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City | ROSEVILLE
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State | CA
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Zip | 95747-4907
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Country | US
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Telephone | 209-756-3563
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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 | 73988
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License Number State | CA
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