Healthcare Provider Details

I. General information

NPI: 1750824140
Provider Name (Legal Business Name): ABDUL AZEEM SHARIFI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2016
Last Update Date: 09/11/2025
Certification Date: 03/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 JUAN TABO BLVD NE
ALBUQUERQUE NM
87112-4469
US

IV. Provider business mailing address

1540 JUAN TABO BLVD NE
ALBUQUERQUE NM
87112-4469
US

V. Phone/Fax

Practice location:
  • Phone: 505-800-7246
  • Fax:
Mailing address:
  • Phone: 505-203-8225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008633
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: