Provider Demographics
NPI:1346500428
Name:MORADI, MASOUD (RPH)
Entity Type:Individual
Prefix:
First Name:MASOUD
Middle Name:
Last Name:MORADI
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 1:1 APPLETREE LN
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1925
Mailing Address - Country:US
Mailing Address - Phone:516-343-2233
Mailing Address - Fax:
Practice Address - Street 1:1 APPLETREE LN
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11024-1925
Practice Address - Country:US
Practice Address - Phone:516-343-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist