Provider Demographics
NPI:1407446404
Name:HUMEIDI, RANEM (RPH)
Entity Type:Individual
Prefix:
First Name:RANEM
Middle Name:
Last Name:HUMEIDI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10727 MAJESTIC STAR
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4753
Mailing Address - Country:US
Mailing Address - Phone:830-765-2011
Mailing Address - Fax:
Practice Address - Street 1:2710 NOGALITOS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78225-1750
Practice Address - Country:US
Practice Address - Phone:210-533-7773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist