Healthcare Provider Details

I. General information

NPI: 1407220841
Provider Name (Legal Business Name): HAMED HAKIMI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 BEAUHAVEN LN
WAXHAW NC
28173-7451
US

IV. Provider business mailing address

947 N MAIN ST
MOORESVILLE NC
28115-2355
US

V. Phone/Fax

Practice location:
  • Phone: 704-942-8132
  • Fax:
Mailing address:
  • Phone: 704-664-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number17924
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: