Provider Demographics
NPI:1154677037
Name:SHOJAI, ABDOLREZA (RPH)
Entity Type:Individual
Prefix:MR
First Name:ABDOLREZA
Middle Name:
Last Name:SHOJAI
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 1:215 E 95TH ST APT 34J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4089
Mailing Address - Country:US
Mailing Address - Phone:516-374-1750
Mailing Address - Fax:
Practice Address - Street 1:215 E 95TH ST APT 34J
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-4089
Practice Address - Country:US
Practice Address - Phone:516-374-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056678-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist