Provider Demographics
NPI:1114533577
Name:HENDI, TAREQ (RPH)
Entity Type:Individual
Prefix:
First Name:TAREQ
Middle Name:
Last Name:HENDI
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 1:777 E STELLA LN APT 410
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-0015
Mailing Address - Country:US
Mailing Address - Phone:415-604-6976
Mailing Address - Fax:
Practice Address - Street 1:15444 N FRANK LLOYD WRIGHT BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2845
Practice Address - Country:US
Practice Address - Phone:480-718-1352
Practice Address - Fax:480-718-1352
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist