Provider Demographics
NPI:1497852578
Name:AHMADY, HAMIDEH (PHARMD BCOPAPH)
Entity Type:Individual
Prefix:DR
First Name:HAMIDEH
Middle Name:
Last Name:AHMADY
Suffix:
Gender:F
Credentials:PHARMD BCOPAPH
Other - Prefix:
Other - First Name:HAMIDEH
Other - Middle Name:
Other - Last Name:TAVAKOLI-AHMADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1501
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93448-1501
Mailing Address - Country:US
Mailing Address - Phone:951-233-5255
Mailing Address - Fax:
Practice Address - Street 1:MISSION HOPE CANCER CENTER (MRMC)
Practice Address - Street 2:1325 E. CHURCH STREET, # 303
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454
Practice Address - Country:US
Practice Address - Phone:805-474-5306
Practice Address - Fax:805-474-3430
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52114183500000X, 1835P1200X, 1835X0200X
IN26021015A183500000X
CAAPH103291835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835X0200XPharmacy Service ProvidersPharmacistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA8174579OtherDL