Provider Demographics
NPI:1083259477
Name:ISRAEL, FARID (RPH)
Entity Type:Individual
Prefix:
First Name:FARID
Middle Name:
Last Name:ISRAEL
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 1:1003 BAYRIDGE TER
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1955
Mailing Address - Country:US
Mailing Address - Phone:405-697-8007
Mailing Address - Fax:
Practice Address - Street 1:2384 BRANDERMILL BLVD
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1850
Practice Address - Country:US
Practice Address - Phone:443-302-6279
Practice Address - Fax:443-302-6289
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-09
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist