Provider Demographics
NPI:1619526738
Name:ALI, TAREK (RPH)
Entity Type:Individual
Prefix:
First Name:TAREK
Middle Name:
Last Name:ALI
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 1:821 N CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-3301
Mailing Address - Country:US
Mailing Address - Phone:310-694-7985
Mailing Address - Fax:
Practice Address - Street 1:3308 N DINUBA BLVD
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-8718
Practice Address - Country:US
Practice Address - Phone:559-302-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist