Provider Demographics
NPI:1346339280
Name:REZAEI, DAVOOD (RPH)
Entity Type:Individual
Prefix:
First Name:DAVOOD
Middle Name:
Last Name:REZAEI
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 1:3953 COBBLESTONE CT
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7237
Mailing Address - Country:US
Mailing Address - Phone:214-857-0156
Mailing Address - Fax:214-462-4990
Practice Address - Street 1:4500 S. LANCASTER RD
Practice Address - Street 2:(8C) CRU
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216
Practice Address - Country:US
Practice Address - Phone:214-857-0156
Practice Address - Fax:214-462-4990
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist