Healthcare Provider Details

I. General information

NPI: 1063339034
Provider Name (Legal Business Name): RANIA MAMO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7059 E BASELINE RD
MESA AZ
85209-4803
US

IV. Provider business mailing address

4760 E BASELINE RD APT 1103
MESA AZ
85206-4686
US

V. Phone/Fax

Practice location:
  • Phone: 480-830-1554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberI026382
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: