Provider Demographics
NPI:1043811458
Name:KERMANI, FARZANEH ESTHER
Entity Type:Individual
Prefix:DR
First Name:FARZANEH
Middle Name:ESTHER
Last Name:KERMANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 TOBIAS BOLAND WAY
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01607-2103
Mailing Address - Country:US
Mailing Address - Phone:774-314-3162
Mailing Address - Fax:774-314-3156
Practice Address - Street 1:25 TOBIAS BOLAND WAY
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01607-2103
Practice Address - Country:US
Practice Address - Phone:774-314-3162
Practice Address - Fax:774-314-3156
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH27659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist