Provider Demographics
NPI:1275077240
Name:ZEBARI, RENJBAR
Entity Type:Individual
Prefix:
First Name:RENJBAR
Middle Name:
Last Name:ZEBARI
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 1:171 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NY
Mailing Address - Zip Code:13838-1349
Mailing Address - Country:US
Mailing Address - Phone:607-563-9911
Mailing Address - Fax:607-563-3952
Practice Address - Street 1:171 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-1349
Practice Address - Country:US
Practice Address - Phone:607-563-9911
Practice Address - Fax:607-563-3952
Is Sole Proprietor?:No
Enumeration Date:2016-12-11
Last Update Date:2016-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI062177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist