Provider Demographics
NPI:1720621741
Name:RAHIM, HATEF
Entity Type:Individual
Prefix:
First Name:HATEF
Middle Name:
Last Name:RAHIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6651 N CAMPBELL AVE APT 226
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-1363
Mailing Address - Country:US
Mailing Address - Phone:520-360-1122
Mailing Address - Fax:
Practice Address - Street 1:10405 N LA CANADA DR
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-6945
Practice Address - Country:US
Practice Address - Phone:520-297-5934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist