Provider Demographics
NPI:1831323906
Name:IMAM, TAWFIQ (RPH)
Entity Type:Individual
Prefix:
First Name:TAWFIQ
Middle Name:
Last Name:IMAM
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 1:1643 MADRID ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-8436
Mailing Address - Country:US
Mailing Address - Phone:646-226-2163
Mailing Address - Fax:
Practice Address - Street 1:540 CANAL ST,
Practice Address - Street 2:RITE AID PHARMACY #5880
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930
Practice Address - Country:US
Practice Address - Phone:831-385-0886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist