Provider Demographics
NPI:1285809467
Name:HAMRAH, PAUL MEHDI (PHARMACIST)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MEHDI
Last Name:HAMRAH
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:MEHDI
Other - Middle Name:PAUL
Other - Last Name:HAMRAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:11824 CYPRESS CANYON RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-5731
Mailing Address - Country:US
Mailing Address - Phone:858-337-7817
Mailing Address - Fax:
Practice Address - Street 1:250 TRAVELODGE DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4126
Practice Address - Country:US
Practice Address - Phone:619-441-3149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48152302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization