Provider Demographics
NPI:1962850495
Name:HAZIME, INAYA MOHAMAD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:INAYA
Middle Name:MOHAMAD
Last Name:HAZIME
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3027
Mailing Address - Country:US
Mailing Address - Phone:916-784-4332
Mailing Address - Fax:
Practice Address - Street 1:9321 STARTING GATE CT
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CA
Practice Address - Zip Code:95693-9249
Practice Address - Country:US
Practice Address - Phone:916-690-8496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH43977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist