Provider Demographics
NPI:1578363099
Name:FOULADI CHAMI, RAEITI
Entity type:Individual
Prefix:
First Name:RAEITI
Middle Name:
Last Name:FOULADI CHAMI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CHECKERS DR APT 101
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-2287
Mailing Address - Country:US
Mailing Address - Phone:408-599-9031
Mailing Address - Fax:
Practice Address - Street 1:200 N WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-6501
Practice Address - Country:US
Practice Address - Phone:408-247-1894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90481183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist