Provider Demographics
NPI:1104411834
Name:BESKHAYROUN, SAMER MALAK (RPH)
Entity type:Individual
Prefix:
First Name:SAMER
Middle Name:MALAK
Last Name:BESKHAYROUN
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 1:1850 S DIAMOND BAR BLVD APT 601
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2921
Mailing Address - Country:US
Mailing Address - Phone:909-979-4075
Mailing Address - Fax:
Practice Address - Street 1:9194 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3872
Practice Address - Country:US
Practice Address - Phone:951-977-8617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist