Provider Demographics
NPI:1154945137
Name:AMIRI, HAMID (PHARMD)
Entity type:Individual
Prefix:
First Name:HAMID
Middle Name:
Last Name:AMIRI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35439 MONTERRA CIR
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-8076
Mailing Address - Country:US
Mailing Address - Phone:801-703-7490
Mailing Address - Fax:
Practice Address - Street 1:5720 NAVE DR
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-6210
Practice Address - Country:US
Practice Address - Phone:801-703-7490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist