Provider Demographics
NPI:1114195682
Name:IZADI, KATAYOUN (RPH)
Entity Type:Individual
Prefix:
First Name:KATAYOUN
Middle Name:
Last Name:IZADI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4708
Mailing Address - Country:US
Mailing Address - Phone:516-873-8600
Mailing Address - Fax:516-873-8604
Practice Address - Street 1:2226 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4708
Practice Address - Country:US
Practice Address - Phone:516-873-8600
Practice Address - Fax:516-873-8604
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY046713OtherNY STATE