Provider Demographics
NPI:1851668438
Name:DHALLA, RAHIM AZIZ (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:RAHIM
Middle Name:AZIZ
Last Name:DHALLA
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 PROVIDENCE PL
Mailing Address - Street 2:SUITE 112
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-7000
Mailing Address - Country:US
Mailing Address - Phone:617-835-8834
Mailing Address - Fax:
Practice Address - Street 1:903 PROVIDENCE PL
Practice Address - Street 2:SUITE 112
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-7000
Practice Address - Country:US
Practice Address - Phone:617-835-8834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233381183500000X
RIRPH05002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist