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General NPI Number Information
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NPI Number | 1487954087
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Entity Type | Individual
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Provider Name | SAMIRA KHATAMI PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/28/2010
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Last Update Date | 10/28/2010
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Provider Practice Location Address
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Address Line | 5130 BROADWAY
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City | OAKLAND
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State | CA
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Zip | 94611-4620
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Country | US
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Telephone | 510-658-5693
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Fax |
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Provider Business Mailing Address
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Address Line | 466 GRAVATT DR
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City | BERKELEY
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State | CA
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Zip | 94705-1506
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Country | US
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Telephone | 510-849-3180
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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 | 60045
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License Number State | CA
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