Provider Demographics
NPI:1194033639
Name:ABHAEI, HAMED (MIKE) (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:HAMED (MIKE)
Middle Name:
Last Name:ABHAEI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 SW 142ND AVE APT 180
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2543
Mailing Address - Country:US
Mailing Address - Phone:503-828-2315
Mailing Address - Fax:
Practice Address - Street 1:16200 SW PACIFIC HWY STE E
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-3471
Practice Address - Country:US
Practice Address - Phone:503-684-7566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0011860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist