Provider Demographics
NPI:1104269752
Name:KARAZE, IMADEDDIN (RPH)
Entity type:Individual
Prefix:
First Name:IMADEDDIN
Middle Name:
Last Name:KARAZE
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:PO BOX 77281
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92877-0109
Mailing Address - Country:US
Mailing Address - Phone:708-942-9896
Mailing Address - Fax:
Practice Address - Street 1:835 N HIGHLAND SPRINGS AVE #110
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223
Practice Address - Country:US
Practice Address - Phone:708-942-9896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-14
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022305A183500000X
MI5302030545183500000X
IL051-296416183500000X
CA70554183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist