=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003385238
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARAAM RIFKAH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2018
-----------------------------------------------------
Last Update Date | 11/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2604 LINGLESTOWN RD
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17110-3622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-540-4310
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4089 CAISSONS CT
-----------------------------------------------------
City | ENOLA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17025-1477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-935-9578
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP452706
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------