Provider Demographics
NPI:1467053959
Name:RAFI, EBNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:EBNE
Middle Name:
Last Name:RAFI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 TACA BLVD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-3442
Mailing Address - Country:US
Mailing Address - Phone:631-629-9100
Mailing Address - Fax:
Practice Address - Street 1:3909 ORANGE PL STE 3100
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4481
Practice Address - Country:US
Practice Address - Phone:216-358-1924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067070183500000X
OH03442161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist