Provider Demographics
NPI:1871880765
Name:SAMAAN, YOUSSEF M (RPH)
Entity type:Individual
Prefix:
First Name:YOUSSEF
Middle Name:M
Last Name:SAMAAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6904 SAVANNAH FALLS DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-1880
Mailing Address - Country:US
Mailing Address - Phone:401-808-1016
Mailing Address - Fax:
Practice Address - Street 1:100 CHINA GRADE LOOP
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-1739
Practice Address - Country:US
Practice Address - Phone:661-393-3358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA65494OtherCALIFORNIA BOARD OF PHARMACY