Provider Demographics
NPI:1114329927
Name:RAMEZANI, SADEGH
Entity Type:Individual
Prefix:
First Name:SADEGH
Middle Name:
Last Name:RAMEZANI
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 1:24 ASPHODEL AVE
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-7930
Mailing Address - Country:US
Mailing Address - Phone:318-450-0884
Mailing Address - Fax:
Practice Address - Street 1:5458 HIGHWAY 56
Practice Address - Street 2:
Practice Address - City:CHAUVIN
Practice Address - State:LA
Practice Address - Zip Code:70344-3102
Practice Address - Country:US
Practice Address - Phone:985-594-5821
Practice Address - Fax:985-594-3280
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist