Provider Demographics
NPI:1639848807
Name:RAHMOUN RAHWAN, DIMA (RPH)
Entity Type:Individual
Prefix:
First Name:DIMA
Middle Name:
Last Name:RAHMOUN RAHWAN
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 1:253 E SUMMER LEAF DR
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5181
Mailing Address - Country:US
Mailing Address - Phone:801-472-7221
Mailing Address - Fax:
Practice Address - Street 1:1818 S 300 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-1805
Practice Address - Country:US
Practice Address - Phone:801-485-9715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8504176-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist