Provider Demographics
NPI:1871313445
Name:SANDO, SAMSON ASHUR
Entity type:Individual
Prefix:
First Name:SAMSON
Middle Name:ASHUR
Last Name:SANDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BELLA DONACI
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-0114
Mailing Address - Country:US
Mailing Address - Phone:702-722-8772
Mailing Address - Fax:
Practice Address - Street 1:3 BELLA DONACI
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-0114
Practice Address - Country:US
Practice Address - Phone:702-722-8772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH198364183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician