Healthcare Provider Details

I. General information

NPI: 1114010527
Provider Name (Legal Business Name): TAOHEED HASAN PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 WEST AVE J SUITE 1
LANCASTER CA
93534
US

IV. Provider business mailing address

1324 WEST AVE J SUITE 7
LANCASTER CA
93534
US

V. Phone/Fax

Practice location:
  • Phone: 661-942-8777
  • Fax: 661-942-8795
Mailing address:
  • Phone: 661-942-8777
  • Fax: 661-942-8795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH38785
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY468660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: