Provider Demographics
NPI:1962574491
Name:LUM, SAMUEL LEE (PHARMD, MBA)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:LEE
Last Name:LUM
Suffix:
Gender:M
Credentials:PHARMD, MBA
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Mailing Address - Street 1:107 EDGEWARE COURT
Mailing Address - Street 2:2809 BETHANY ROAD
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582
Mailing Address - Country:US
Mailing Address - Phone:925-779-5496
Mailing Address - Fax:925-779-5468
Practice Address - Street 1:3400 DELTA FAIR BLVD.
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509
Practice Address - Country:US
Practice Address - Phone:925-779-5496
Practice Address - Fax:925-779-5468
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA476081835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy