Suzan Abu Rajab Tamimi

Key facts

NPI

1104554443

Entity type

Individual (NPI type 1)

Primary specialty

Pharmacist 183500000X

License

82585 (CA)

Practice address

2000 Driscoll Rd
Fremont, CA 94539-4446

Phone

(510) 770-8571

NPI assigned

Aug 14, 2022

Sex

Female

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Longs Drug Store California LLC Pharmacy · Kapolei, HI · NPI 1700565793
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 14, 2022.

{
    "created_epoch": "1660435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660435200000",
    "number": "1104554443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10787 SORNOWAY LN",
            "city": "DUBLIN",
            "state": "CA",
            "postal_code": "945685518",
            "telephone_number": "858-231-4963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 DRISCOLL RD",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945394446",
            "telephone_number": "510-770-8571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABU RAJAB TAMIMI",
        "first_name": "SUZAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-14",
        "last_updated": "2022-08-14",
        "certification_date": "2022-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "82585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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