Provider Demographics
NPI:1093808552
Name:ARYAN, ABDEL R
Entity Type:Individual
Prefix:MR
First Name:ABDEL
Middle Name:R
Last Name:ARYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 HOMESTEAD RD NO.
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936
Mailing Address - Country:US
Mailing Address - Phone:239-369-0141
Mailing Address - Fax:239-368-0843
Practice Address - Street 1:57 HOMESTEAD RD NO.
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936
Practice Address - Country:US
Practice Address - Phone:239-369-0141
Practice Address - Fax:239-368-0843
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0024737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist