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General NPI Number Information
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NPI Number | 1932599594
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Entity Type | Individual
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Provider Name | SHAUNA JOYCE SAMUEL
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Gender | Female
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 13463 WASHINGTON BLVD
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5658
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Country | US
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Telephone | 310-754-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 10866 WASHINGTON BLVD # 731
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City | CULVER CITY
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State | CA
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Zip | 90232-3610
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Country | US
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Telephone | 310-817-3044
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 61493
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License Number State | CA
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