1497852578 NPI number — DR. HAMIDEH AHMADY PHARM.D. BCOP.APH

Table of content: DR. HAMIDEH AHMADY PHARM.D. BCOP.APH (NPI 1497852578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497852578 NPI number — DR. HAMIDEH AHMADY PHARM.D. BCOP.APH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHMADY
Provider First Name:
HAMIDEH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D. BCOP.APH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAVAKOLI-AHMADY
Provider Other First Name:
HAMIDEH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497852578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1501
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PISMO BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93448-1501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-233-5255
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MISSION HOPE CANCER CENTER (MRMC)
Provider Second Line Business Practice Location Address:
1325 E. CHURCH STREET, # 303
Provider Business Practice Location Address City Name:
SANTA MARIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-474-5306
Provider Business Practice Location Address Fax Number:
805-474-3430
Provider Enumeration Date:
09/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  52114 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 26021015A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835P1200X , with the licence number: 52114 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835X0200X , with the licence number: 52114 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835P0018X , with the licence number: APH10329 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A8174579 . This is a "DL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".