Basic Information
| Provider Information | |||||||||
| NPI: | 1497852578 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAVAKOLI-AHMADY | ||||||||
| FirstName: | HAMIDEH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHARM.D. BCOP.APH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 300 | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923540290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074458121 | ||||||||
| FaxNumber: | 7072681980 | ||||||||
| Practice Location | |||||||||
| Address1: | ST. JOSEPH HOSPITAL | ||||||||
| Address2: | 2700 DOLBEER AVE. | ||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074458121 | ||||||||
| FaxNumber: | 7072681980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 06/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 52114 | CA | N | Pharmacy Service Providers | Pharmacist | 183500000X | 26021015A | IN | N | Pharmacy Service Providers | Pharmacist | 1835P1200X | 52114 | CA | N | Pharmacy Service Providers | Pharmacist | Pharmacotherapy | 1835X0200X | 52114 | CA | N | Pharmacy Service Providers | Pharmacist | Oncology | 1835P0018X | APH10329 | CA | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
ID Information
| ID | Type | State | Issuer | Description | A8174579 | 01 | CA | DL | OTHER |