Provider Demographics
NPI:1679106876
Name:ABEDI-TARI, MAXEEM RANA
Entity Type:Individual
Prefix:
First Name:MAXEEM
Middle Name:RANA
Last Name:ABEDI-TARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2343 SUMMERCREEK DR APT 80
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-7763
Mailing Address - Country:US
Mailing Address - Phone:978-799-3181
Mailing Address - Fax:
Practice Address - Street 1:100 CALISTOGA RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-3702
Practice Address - Country:US
Practice Address - Phone:707-539-2129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-16
Last Update Date:2020-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH81988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist