Provider Demographics
NPI:1538575071
Name:ATIEH, YAZID (PHC)
Entity type:Individual
Prefix:
First Name:YAZID
Middle Name:
Last Name:ATIEH
Suffix:
Gender:M
Credentials:PHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3865 E LOHMAN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8292
Mailing Address - Country:US
Mailing Address - Phone:575-915-1538
Mailing Address - Fax:
Practice Address - Street 1:3865 E LOHMAN AVE STE 2
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8292
Practice Address - Country:US
Practice Address - Phone:575-915-1538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-04
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPC000002821835P0018X
NMRP00007426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty