Provider Demographics
NPI:1235727009
Name:ROSTAMIZADEH, HAMID (RPH)
Entity Type:Individual
Prefix:
First Name:HAMID
Middle Name:
Last Name:ROSTAMIZADEH
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 1:3000 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5003
Mailing Address - Country:US
Mailing Address - Phone:215-342-7700
Mailing Address - Fax:
Practice Address - Street 1:7350 OXFORD AVE STE C
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3021
Practice Address - Country:US
Practice Address - Phone:215-342-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty