Provider Demographics
NPI:1962148957
Name:MOHAREB, HANI VICTOR
Entity type:Individual
Prefix:DR
First Name:HANI
Middle Name:VICTOR
Last Name:MOHAREB
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 1:5442 AGOSTINO CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-2421
Mailing Address - Country:US
Mailing Address - Phone:408-913-3615
Mailing Address - Fax:
Practice Address - Street 1:5442 AGOSTINO CT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-2421
Practice Address - Country:US
Practice Address - Phone:408-913-3615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86055183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist