Provider Demographics
NPI:1003091265
Name:SAMOUHI, FARIBORZ (RPH)
Entity Type:Individual
Prefix:
First Name:FARIBORZ
Middle Name:
Last Name:SAMOUHI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142A MANETTO HILL RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1310
Mailing Address - Country:US
Mailing Address - Phone:516-932-7077
Mailing Address - Fax:516-932-1971
Practice Address - Street 1:142A MANETTO HILL RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1310
Practice Address - Country:US
Practice Address - Phone:516-932-7077
Practice Address - Fax:516-932-1971
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0365521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist