Provider Demographics
NPI:1245413079
Name:NOURI, PARASTOU
Entity Type:Individual
Prefix:
First Name:PARASTOU
Middle Name:
Last Name:NOURI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1598 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1762
Mailing Address - Country:US
Mailing Address - Phone:516-616-0482
Mailing Address - Fax:516-616-0489
Practice Address - Street 1:1598 UNION TPKE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1762
Practice Address - Country:US
Practice Address - Phone:516-616-0482
Practice Address - Fax:516-616-0489
Is Sole Proprietor?:No
Enumeration Date:2007-12-15
Last Update Date:2007-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist