Provider Demographics
NPI:1437784386
Name:ABDELAZEEM, AHMED (RPH)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:ABDELAZEEM
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 1:464 VEREDA DEL CIERVO
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-5324
Mailing Address - Country:US
Mailing Address - Phone:415-490-7820
Mailing Address - Fax:
Practice Address - Street 1:218 E HIGHWAY 246 BLDG 3
Practice Address - Street 2:
Practice Address - City:BUELLTON
Practice Address - State:CA
Practice Address - Zip Code:93427-9654
Practice Address - Country:US
Practice Address - Phone:805-693-1132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist