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General NPI Number Information
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NPI Number | 1801157292
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Entity Type | Individual
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Provider Name | SAM HADDAD
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Gender | Male
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Dates
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Enumeration Date | 06/02/2012
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Last Update Date | 06/02/2012
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Provider Practice Location Address
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Address Line | 6400 HAVEN AVE
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City | ALTA LOMA
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State | CA
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Zip | 91737-3823
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Country | US
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Telephone | 909-941-3857
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Fax |
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Provider Business Mailing Address
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Address Line | 1752 HENDERSON WAY
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City | UPLAND
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State | CA
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Zip | 91784-9276
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Country | US
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Telephone | 909-565-5311
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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 | 67044
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License Number State | CA
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